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* 1. Which one of our departments did you recently visit at our Potosi location?

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* 2. How easy or difficult was it to schedule your appointment at a time that was convenient for you?

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* 3. How easy was it for you to make a same-day appointment when you had an emergency?

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* 4. How easy are you able to get medical/dental advice when the office is closed?

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* 5. Do you feel as though your nurse/assistant listens to you?

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* 6. Is your nurse/assistant friendly and helpful to you?

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* 7. Does your nurse/assistant answer your questions?

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* 8. Do you feel your provider listens to you?

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* 9. Do you feel your provider answers your questions?

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* 10. Do you feel your provider is friendly and helpful to you?

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* 11. Does your provider involve other doctors or providers in your care when needed?

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* 12. Were you asked if you had visits with other healthcare providers since your last visit with us?

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* 13. How long was your wait time in the waiting room?

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* 14. How long was your wait time in the exam room?

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* 15. Were you helped with making appointments to see other providers or for specialty care?

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* 16. You may need other services that we do not provide.  Have we helped you find other services you need?

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* 17. Do you feel we help you to make healthy lifestyle choices?

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* 18. Will you return to GMHC for care?

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* 19. Will you recommend GMHC to friends/family?

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* 20. Overall, was the facility clean?

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* 21. How are our costs, collections, and explanation of benefits in comparison to other local healthcare providers providing similar services?

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* 22. Please provide any suggestions or additional feedback.

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* 23. Provide your name and contact information, so you can be entered into our drawing for a chance to win a prize!

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