Patient Experience of Care Survey This survey is secure and HIPAA compliant * 1. How likely is it that you would recommend RBOI to a friend or family member? Not at all likely Extremely likely 0 1 2 3 4 5 6 7 8 9 10 Not at all likely - 0 1 2 3 4 5 6 7 8 9 Extremely likely - 10 * 2. On your last visit, did your doctor explain things in a way that was easy to understand? Yes No * 3. Did your doctor listen carefully to you? Yes No * 4. Did your doctor answer all of your questions and concerns? Yes No * 5. Did your doctor seem to know the important information about your medical history? Yes No * 6. Did your doctor show respect for what you had to say? Yes No * 7. Did your doctor spend enough time with you? Yes No * 8. How much do you trust your provider to make medical decisions that are in your best interests? A great deal A lot A moderate amount A little Not at all * 9. In your opinion, how convenient is the location of our office? Extremely convenient Very convenient Somewhat convenient Not so convenient Not at all convenient * 10. How comfortable was the lobby and waiting area? Extremely comfortable Very comfortable Somewhat comfortable Not so comfortable Not at all comfortable * 11. Did your appointment with your provider start early, late or on time? Very early Somewhat early On time Somewhat late Very late * 12. Would you like to provide any other feedback? Done