Patient Experience Survey Question Title * 1. Survey Date Date / Time Date Question Title * 2. Which Provider was your appointment with: Kevin Akor, PA Odelle Kamani, FNP Sidney Nelson, III, MD Lisa Sindass, MD Scott Whetsell, MD Question Title * 3. Type of Appointment New Patient Follow-up Well Visit After Hospital Admission Review Test Results EKG Tele-Health Visit MAT / Suboxone / Vivitrol Physical Therapy Question Title * 4. Did you get your appointment as soon as you needed it. Yes No Question Title * 5. Did the office staff treat you with dignity and respect Yes No Question Title * 6. Were you seen within 15 minutes of your appointment time Yes No Question Title * 7. Did the nurse treat you with courtesy and respect Yes No Question Title * 8. Did your Physician / Nurse Practitioner listen carefully to what you had to say Extremely satisfied Satisfied Neutral Dissatisfied Extremely dissatisfied If desired please explain Question Title * 9. Did your provider spend enough time with you during your appointment Extremely satisfied Satisfied Neutral Dissatisfied Extremely dissatisfied If desired please explain Question Title * 10. Physicians and nurses care for me as a "whole person" rather than just the illness for which I present during my visit. No Yes Question Title * 11. My physician coordinates my care appropriately with other physicians/specialists and required testing services Yes No Question Title * 12. Please provide any additional comments about your visit Done
