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* 1. Reason for Visit:

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* 2. Did you have difficulty getting an appointment

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* 3. If you were requesting an appointment due to having signs and symptoms of illness, did we see you (by appointment) within the next 24 hours?

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* 4. Did you understand the information you were given today?

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* 5. Convenience of the location of the office?

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* 6. Length of time waiting at office?

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* 7. Time spent with person/people you saw?

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* 8. Explanation of what was done for you?

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* 9. The technical skills (thoroughness,carefulness, competence) of the person you saw?

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* 10. The personal manner (courtesy, respect, sensitivity, friendliness) of the person you saw?

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* 11. Office hours suitable to your needs?

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* 12. Comments:

0 of 12 answered
 

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