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* 1. Please rate your overall experience using Health Services

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* 2. Were you treated courteously by staff?

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* 3. Were staff members attentive to your needs/problems?

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* 4. Did the clinician (nurse/nurse practitioner/doctor) explain the nature of your illness/problem in understndable terms?

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* 5. Were the treatment and health instructions explained clearly?

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* 6. Did the clinician allow time to listen to and answer your questions?

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* 7. How satisfied were you with how your problem was addressed?

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* 8. How satisfied were you with the treatment offered to assist you with your problem?

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* 9. How satisfied were you with the amount of time spent with you?

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* 10. Please offer suggestions to improve the program.

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