Which Physician was your appointment with

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* 1. Which Physician was your appointment with

Type of Appointment

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* 2. Type of Appointment

Did you get your appointment as soon as you needed it.

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* 3. Did you get your appointment as soon as you needed it.

Did the office staff treat you with dignity and respect

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* 4. Did the office staff treat you with dignity and respect

Were you seen within 15 minutes of your appointment time

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* 5. Were you seen within 15 minutes of your appointment time

Did the nurse treat you with courtesy and respect

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* 6. Did the nurse treat you with courtesy and respect

Did your physician listen carefully to what you had to say

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* 7. Did your physician listen carefully to what you had to say

Did your provider spend enough time with you during your appointment

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* 8. Did your provider spend enough time with you during your appointment

Physicians and nurses care for me as a "whole person" rather than just the illness for which I present during my visit.

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* 9. Physicians and nurses care for me as a "whole person" rather than just the illness for which I present during my visit.

My physician coordinates my care appropriately with other physicians/specialists and required testing services

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* 10. My physician coordinates my care appropriately with other physicians/specialists and required testing services

Please provide any additional comments about your visit

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* 11. Please provide any additional comments about your visit

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