We would like to know how you feel about the services we provide so we can make sure we are meeting your needs.  Your responses are directly responsible for improving these services.  All responses will be kept confidential and anonymous. 

Thank you for your time.

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* 1. Your Age:

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* 2. Select provider at our office you typically see:

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* 3. Your Health

  Excellent Good OK Fair Poor
How would you rate your overall health?

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* 4. Ease of Getting Care (select how we are doing in each area)

  Excellent Good OK Fair Poor N/A
Ability to make appointment when needed
Convenience of office hours
Convenience of office location
Prompt return of phone calls when you have medical concern
Address your needs when you contact after hours team

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* 5. Visit Experience (select how we are doing in each area)

  Excellent Good OK Fair Poor N/A
Time in waiting room
Time in exam room
Neat and clean building
Privacy in our facility

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* 6. Provider Experience (select how we are doing in each area)

  Excellent Good OK Fair Poor N/A
Amount of time provider spends with you
Provider listens to you
Provider explains things in a way that is easy to understand
Provider includes you in decisions about your care
How well you understand what you need to do after your visit
Provider gives you good advice and treatment
Helps you with diet, regular exercise and emotional well-being
Provider regularly reviews all of your medications

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* 7. Staff Experience (select how we are doing in each area)

  Excellent Good OK Fair Poor N/A
Nursing team and medical assistants are friendly and helpful
Other staff (ex: reception) are friendly and helpful at your visit
When you call the office, phone operators are friendly and helpful

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* 8. Telehealth Visits (select most accurate response)

  BETTER than In-Office Visit SAME as In-Office Visit NOT AS GOOD as In-Office Visit I have not had a telehealth visit
Ease of scheduling a convenient appointment time
Ability to be seen by a provider when needed
Overall quality of your visit
Quality of discussion with your provider

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* 9. Preference Related to Telehealth Visits (select most accurate response)

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* 10. Communication (select how we are doing in each area)

  Excellent Good OK Fair Poor N/A
Office promptly return phone calls
Office promptly responds to portal messages
Office provides lab/test results timely

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* 11. How do you prefer to receive the following (select all that apply)

  Phone Portal Text Email
General health education information
Appointment reminders
Notice that lab/test results are available

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* 12. Financial Experience (select how we are doing in each area)

  Excellent Good OK Fair Poor N/A
How well does our billing staff explain charges on statements
How well does our billing staff address your questions
How is your experience with making payment to our office

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* 13. Overall Experience (select how we are doing in each area)

  Excellent Good OK Fair Poor N/A
What is your overall experience with our office
How well we keep your personal information private
Likelihood that you would refer friends and relative to us for care

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* 14. What do you like best about our office?

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* 15. Do you have suggestions for improvement?

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