* 1. During your most recent visit, did your healthcare provider listen carefully to you?

* 2. During your most recent visit, did your healthcare provider explain things in a way that was easy to understand?

* 3. During your most recent visit, did your healthcare provider seem to know the important information about your medical history?

* 4. How well does your doctor explain how to take your medicine(s)?

* 5. How well does your doctor answer your questions?

* 6. How friendly is your doctor's office staff?

* 7. How knowledgeable is your doctor's office staff?

* 8. Overall, are you satisfied with your doctor, dissatisfied with your doctor, or neither satisfied nor dissatisfied?

* 9. How likely are you to recommend your doctor to family or friends?

* 10. What suggestions do you have for improving this practice?

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