* 1. Please check the box beside the name of the doctor or nurse practitioner you are seeing today:

* 2. Was the amount of time you had to wait to get this appointment with a doctor or nurse practitioner reasonable? 

* 3. How satisfied are you with your overall experience with our reception staff? 

* 4. How often does the doctor, nurse practitioner or someone else in the office involve you (as much as you want to be) in the decisions about your care and treatment?

* 5. Comments

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