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GAP Clinic Patient Survey
1.
I recently had an appointment at the following office:
Winston-Salem
Kernersville
Clemmons
2.
I saw the following provider at that appointment:
Dr. Barry
Dr. Campbell
Dr. Cengia
Dr. Connolley
Dr. Cornella
Dr. Holmes
Dr. Jones
Dr. McKimmie
Dr. Mixon
Dr. Murphy
Dr. Patwa
Dr. Peters
Dr. Scott
Dr. Shogbesan
Dr. Smith
Dr. Surles
Dr. Sweeney
Paul Gregory, NP-C
Christa Hubert, PA-C
Alexander Lee, PA-C
Kari McChesney, NP-C
Kristen Rinkenberg, PA-C
Ashley Schmidt, NP-C
Gabrielle Ventura, PA-C
3.
I heard about GAP from...
Friend, family member, or colleague
Referred by a physician
Internet Search
Community Event
Employer Health Fair
Advertisement
Somewhere else/I don't remember.
4.
I would recommend GAP to a friend, family member, or colleague.
Strongly agree
Agree
Neither agree nor disagree
Disagree
Strongly disagree
5.
At my appointment, the providers and staff listened to, respected, and took the necessary time to answer my questions.
Strongly agree
Agree
N/A - Neither agree nor disagree
Disagree
Strongly disagree
6.
I feel that I was given enough information at my appointment to appropriately manage my health.
Strongly agree
Agree
N/A - Neither agree nor disagree
Disagree
Strongly disagree
7.
I feel that I am able to receive routine, urgent and after-hours care from GAP when I need it.
Strongly agree
Agree
N/A - Neither agree nor disagree
Disagree
Strongly disagree
8.
In the past when blood work, procedures or other tests were ordered for me, GAP gave me those results within 3 business days.
Strongly agree
Agree
N/A - Neither agree nor disagree
Disagree
Strongly disagree
9.
In the past when I have called GAP with a question, I received a response within one business day.
Strongly agree
Agree
N/A - Neither agree nor disagree
Disagree
Strongly disagree
10.
I feel that GAP sufficiently communicates my care plan with my primary care physician.
Strongly agree
Agree
N/A - Neither agree nor disagree
Disagree
Strongly disagree
11.
The following obstacles might keep me from receiving proper care with GAP:
Access to transportation
Distance from home
Financial/Insurance
Language barrier
Health status due to age
Health status due to mental/physical disability
Chronic illness
N/A - Not applicable to me
12.
Use this space to provide any comments or feedback regarding your experience. If you have questions or would like to discuss your feedback with management, please contact us at (336) 448-2427.