PFC Patient Experience Survey Question Title Which provider did you see? Ann C. Lowry, MD Bradford Sklow, MD Amy J. Thorsen, MD Judith L. Trudel, MD, MSc, MHPE Sarah A. Vogler, MD Susan Ness, RN, BSN, BCB-PMD Other (please specify) Question Title Overall, how satisfied or dissatisfied were you with your visit ? Very satisfied Somewhat satisfied Neither satisfied nor dissatisfied Somewhat dissatisfied Very dissatisfied Question Title Overall, how would you rate the service you received from the staff? Excellent Very good Good Fair Poor Question Title Did your appointment start early, late or on time? Very early Somewhat early On time Somewhat late Very late Question Title Overall, how would you rate the care you received from your provider? Excellent Very good Good Fair Poor Question Title How well did your provider answer your questions and explain treatment options/follow up care? Extremely well Very well Moderately well Slightly well Not at all well Question Title How likely is it that you would recommend your provider to family, friends, or colleagues? Not at all0 1 2 3 4 5 6 7 8 9 Extremely likely10 Not at all0 1 2 3 4 5 6 7 8 9 Extremely likely10 Question Title Thank you for completing our survey. Your feedback is greatly appreciated! Name (optional) Phone Number Question Title Is there anything we could have done to improve your visit? If you would like to discuss your experience in more detail or if we can be of further assistance please contact our Director, Clinic Services at 651-312-1573. Done
