* 1. The last time you were sick or were concerned you had a health problem, how many days did it take from when you first tried to see your doctor or nurse practitioner to when you actually SAW him/her?

 
Same day
Next day
2-3 days
4 - 19 days (enter number of days: _____)
20 or more days
Not applicable 

* 2. Your experience as a patient.

  Always Often Sometimes Rarely Never Not applicable 
When your doctor or nurse was not available, how often are you offered other options (wait list, nurse practitioner, nurse, after hours clinic)?
When you see your doctor or nurse practitioner, how often do they  give you an opportunity to ask questions about recommended treatment?
When you see your doctor or nurse practitioner, how often do they involve you as much as you want to be in decisions about your care and treatment?
When you see your doctor or nurse practitioner, how often do they  spend enough time with you?

* 3. In the last 12 months, how many times did you visit your doctor or nurse practitioner to get care for yourself?

* 4. After your scheduled time, on average, how long do you wait for your appointment? (Wait time includes time spend in the waiting room and exam room).

* 5. What is your gender?

* 6. What is your age?

* 7. Do you have any other comments

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