* 1. Do you have one person or group that you think of as your personal doctor or healthcare team?

* 2. If you answered yes to question 1, please name that person or group?

* 3. How easy has it been for you to do/get the following?

  Very Difficult Difficult Neither Difficult or Easy Easy Very Easy
Get medical care when you need it
Make appointments

* 4. How easy has it been for you to do/get the following?

  Does Not Apply Very Difficult Difficult Neither Difficult or Easy Easy Very Easy
Get prescriptions refilled
Get lab results
Talk to a nurse
Talk to a doctor

* 5. When you visit your doctor's office, how often is it well organized and not wasteful of your time?

* 6. At this office, how often do the following people listen and respond to what you have to say in a way that is respectful and courteous?

  Never Rarely Sometimes Often Very Often
Appointment Scheduler
Receptionist
Nurse/MA
Physician/Provider

* 7. Does your doctor or healthcare team explain things in a way that is easy to understand?

* 8. Comments

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