New Patient Question Title * 1. Rate the ease of scheduling an appointment Extremely easy Very easy Moderately easy Slightly easy Not easy at all Other (please specify) Question Title * 2. Rate ease of navigating the patient portal Extremely easy Very easy Moderately easy Slightly easy Not easy at all Other (please specify) Question Title * 3. Rate the information provided to you prior to your appointment Helpful Not helpful None provided Other (please specify) Question Title * 4. Convenience of office location and parking Extremely Convenient Very convenient Moderately convenient Slightly convenient Not convenient at all Other (please specify) Question Title * 5. Overall Office environment cleanliness and comfort Extremely clean and comfortable Very clean and comfortable Moderately clean and comfortable Slightly clean and comfortable Poor, not clean and comfortable Other (please specify) Question Title * 6. Rate the responsiveness and courtesy of our staff Extremely responsive and courteous Very responsive and courteous Moderately responsive and courteous Slightly responsive and courteous Not responsive and courteous Other (please specify) Question Title * 7. How well did the Provider listen and answer questions Extremely well Very well Well Poorly Very Poorly Other (please specify) Question Title * 8. How well did the Provider explain your condition Extremely well Very well Well Poorly Very poorly Other (please specify) Question Title * 9. How likely are you to recommend GCSA to a family member or friend Extremely likely Very likely Somewhat likely Not Likely Would not recomend Other (please specify) Question Title * 10. What can we do to improve? What are we doing well? Done