Preventive Medicine Associates Patient Survey

We would like to know how you feel about the services we provide so we can make sure we are meeting your needs. Your responses are directly responsible for improving these services. All responses will be kept confidential and anonymous.

Thank you for your time.

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* 1. Your Age:

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* 2. Select provider at our office you typically see:

Joseph Barry, MD

Alexander Knudsen, MD

Judith Garrett, FNP

Jennifer Castro, FNP

Ellen Lynne Carey, FNP

Zoryana Bosak, FNP

Melanie Davis, FNP

Nancy Popps, FNP

Terry Kelly, ANP

Jane Choi, PA-C

Other (specify)

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* 3. Your Health

	Excellent	Good	OK	Fair	Poor
How would you rate your overall health?	How would you rate your overall health? Excellent	How would you rate your overall health? Good	How would you rate your overall health? OK	How would you rate your overall health? Fair	How would you rate your overall health? Poor

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* 4. Ease of Getting Care (select how we are doing in each area)

	Excellent	Good	OK	Fair	Poor	N/A
Ability to make appointment when needed	Ability to make appointment when needed Excellent	Ability to make appointment when needed Good	Ability to make appointment when needed OK	Ability to make appointment when needed Fair	Ability to make appointment when needed Poor	Ability to make appointment when needed N/A
Convenience of office hours	Convenience of office hours Excellent	Convenience of office hours Good	Convenience of office hours OK	Convenience of office hours Fair	Convenience of office hours Poor	Convenience of office hours N/A
Convenience of office location	Convenience of office location Excellent	Convenience of office location Good	Convenience of office location OK	Convenience of office location Fair	Convenience of office location Poor	Convenience of office location N/A
Prompt return of phone calls when you have medical concern	Prompt return of phone calls when you have medical concern Excellent	Prompt return of phone calls when you have medical concern Good	Prompt return of phone calls when you have medical concern OK	Prompt return of phone calls when you have medical concern Fair	Prompt return of phone calls when you have medical concern Poor	Prompt return of phone calls when you have medical concern N/A
Address your needs when you contact after hours team	Address your needs when you contact after hours team Excellent	Address your needs when you contact after hours team Good	Address your needs when you contact after hours team OK	Address your needs when you contact after hours team Fair	Address your needs when you contact after hours team Poor	Address your needs when you contact after hours team N/A

Add additional comments as desired:

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* 5. Visit Experience (select how we are doing in each area)

	Excellent	Good	OK	Fair	Poor	N/A
Time in waiting room	Time in waiting room Excellent	Time in waiting room Good	Time in waiting room OK	Time in waiting room Fair	Time in waiting room Poor	Time in waiting room N/A
Time in exam room	Time in exam room Excellent	Time in exam room Good	Time in exam room OK	Time in exam room Fair	Time in exam room Poor	Time in exam room N/A
Neat and clean building	Neat and clean building Excellent	Neat and clean building Good	Neat and clean building OK	Neat and clean building Fair	Neat and clean building Poor	Neat and clean building N/A
Privacy in our facility	Privacy in our facility Excellent	Privacy in our facility Good	Privacy in our facility OK	Privacy in our facility Fair	Privacy in our facility Poor	Privacy in our facility N/A

Add additional comments as desired:

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* 6. Provider Experience (select how we are doing in each area)

	Excellent	Good	OK	Fair	Poor	N/A
Amount of time provider spends with you	Amount of time provider spends with you Excellent	Amount of time provider spends with you Good	Amount of time provider spends with you OK	Amount of time provider spends with you Fair	Amount of time provider spends with you Poor	Amount of time provider spends with you N/A
Provider listens to you	Provider listens to you Excellent	Provider listens to you Good	Provider listens to you OK	Provider listens to you Fair	Provider listens to you Poor	Provider listens to you N/A
Provider explains things in a way that is easy to understand	Provider explains things in a way that is easy to understand Excellent	Provider explains things in a way that is easy to understand Good	Provider explains things in a way that is easy to understand OK	Provider explains things in a way that is easy to understand Fair	Provider explains things in a way that is easy to understand Poor	Provider explains things in a way that is easy to understand N/A
Provider includes you in decisions about your care	Provider includes you in decisions about your care Excellent	Provider includes you in decisions about your care Good	Provider includes you in decisions about your care OK	Provider includes you in decisions about your care Fair	Provider includes you in decisions about your care Poor	Provider includes you in decisions about your care N/A
How well you understand what you need to do after your visit	How well you understand what you need to do after your visit Excellent	How well you understand what you need to do after your visit Good	How well you understand what you need to do after your visit OK	How well you understand what you need to do after your visit Fair	How well you understand what you need to do after your visit Poor	How well you understand what you need to do after your visit N/A
Provider gives you good advice and treatment	Provider gives you good advice and treatment Excellent	Provider gives you good advice and treatment Good	Provider gives you good advice and treatment OK	Provider gives you good advice and treatment Fair	Provider gives you good advice and treatment Poor	Provider gives you good advice and treatment N/A
Helps you with diet, regular exercise and emotional well-being	Helps you with diet, regular exercise and emotional well-being Excellent	Helps you with diet, regular exercise and emotional well-being Good	Helps you with diet, regular exercise and emotional well-being OK	Helps you with diet, regular exercise and emotional well-being Fair	Helps you with diet, regular exercise and emotional well-being Poor	Helps you with diet, regular exercise and emotional well-being N/A
Provider regularly reviews all of your medications	Provider regularly reviews all of your medications Excellent	Provider regularly reviews all of your medications Good	Provider regularly reviews all of your medications OK	Provider regularly reviews all of your medications Fair	Provider regularly reviews all of your medications Poor	Provider regularly reviews all of your medications N/A

Add additional comments as desired:

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* 7. Staff Experience (select how we are doing in each area)

	Excellent	Good	OK	Fair	Poor	N/A
Nursing team and medical assistants are friendly and helpful	Nursing team and medical assistants are friendly and helpful Excellent	Nursing team and medical assistants are friendly and helpful Good	Nursing team and medical assistants are friendly and helpful OK	Nursing team and medical assistants are friendly and helpful Fair	Nursing team and medical assistants are friendly and helpful Poor	Nursing team and medical assistants are friendly and helpful N/A
Other staff (ex: reception) are friendly and helpful at your visit	Other staff (ex: reception) are friendly and helpful at your visit Excellent	Other staff (ex: reception) are friendly and helpful at your visit Good	Other staff (ex: reception) are friendly and helpful at your visit OK	Other staff (ex: reception) are friendly and helpful at your visit Fair	Other staff (ex: reception) are friendly and helpful at your visit Poor	Other staff (ex: reception) are friendly and helpful at your visit N/A
When you call the office, phone operators are friendly and helpful	When you call the office, phone operators are friendly and helpful Excellent	When you call the office, phone operators are friendly and helpful Good	When you call the office, phone operators are friendly and helpful OK	When you call the office, phone operators are friendly and helpful Fair	When you call the office, phone operators are friendly and helpful Poor	When you call the office, phone operators are friendly and helpful N/A

Add additional comments as desired:

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* 8. Telehealth Visits (select most accurate response):

	BETTER than In-Office Visit	SAME as In-Office Visit	NOT AS GOOD as In-Office Visit	I have not had a telehealth visit
Ease of scheduling a convenient appointment time	Ease of scheduling a convenient appointment time BETTER than In-Office Visit	Ease of scheduling a convenient appointment time SAME as In-Office Visit	Ease of scheduling a convenient appointment time NOT AS GOOD as In-Office Visit	Ease of scheduling a convenient appointment time I have not had a telehealth visit
Ability to be seen by a provider when needed	Ability to be seen by a provider when needed BETTER than In-Office Visit	Ability to be seen by a provider when needed SAME as In-Office Visit	Ability to be seen by a provider when needed NOT AS GOOD as In-Office Visit	Ability to be seen by a provider when needed I have not had a telehealth visit
Overall quality of your visit	Overall quality of your visit BETTER than In-Office Visit	Overall quality of your visit SAME as In-Office Visit	Overall quality of your visit NOT AS GOOD as In-Office Visit	Overall quality of your visit I have not had a telehealth visit
Quality of discussion with your provider	Quality of discussion with your provider BETTER than In-Office Visit	Quality of discussion with your provider SAME as In-Office Visit	Quality of discussion with your provider NOT AS GOOD as In-Office Visit	Quality of discussion with your provider I have not had a telehealth visit

Add additional comments as desired:

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* 9. Preference Related to Telehealth:

I prefer to use telehealth as much as possible, when clinically appropriate

I prefer a mix of using telehealth and coming into the office

I do not prefer telehealth visits

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* 10. Communication (select how we are doing in each area)

	Excellent	Good	OK	Fair	Poor	N/A
Office promptly return phone calls	Office promptly return phone calls Excellent	Office promptly return phone calls Good	Office promptly return phone calls OK	Office promptly return phone calls Fair	Office promptly return phone calls Poor	Office promptly return phone calls N/A
Office promptly responds to portal messages	Office promptly responds to portal messages Excellent	Office promptly responds to portal messages Good	Office promptly responds to portal messages OK	Office promptly responds to portal messages Fair	Office promptly responds to portal messages Poor	Office promptly responds to portal messages N/A
Office provides lab/test results timely	Office provides lab/test results timely Excellent	Office provides lab/test results timely Good	Office provides lab/test results timely OK	Office provides lab/test results timely Fair	Office provides lab/test results timely Poor	Office provides lab/test results timely N/A

Add additional comments as desired:

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* 11. How do you prefer to receive the following (select all that apply)

	Phone	Portal	Text	Email
General health education information	General health education information Phone	General health education information Portal	General health education information Text	General health education information Email
Appointment reminders	Appointment reminders Phone	Appointment reminders Portal	Appointment reminders Text	Appointment reminders Email
Notice that lab/test results are available	Notice that lab/test results are available Phone	Notice that lab/test results are available Portal	Notice that lab/test results are available Text	Notice that lab/test results are available Email
Lab/test results (Text/Email Not Available)	Lab/test results (Text/Email Not Available) Phone	Lab/test results (Text/Email Not Available) Portal	Lab/test results (Text/Email Not Available) Text	Lab/test results (Text/Email Not Available) Email

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* 12. Financial Experience (select how we are doing in each area)

	Excellent	Good	OK	Fair	Poor	N/A
How well does our billing staff explain charges on statements	How well does our billing staff explain charges on statements Excellent	How well does our billing staff explain charges on statements Good	How well does our billing staff explain charges on statements OK	How well does our billing staff explain charges on statements Fair	How well does our billing staff explain charges on statements Poor	How well does our billing staff explain charges on statements N/A
How well does our billing staff address your questions	How well does our billing staff address your questions Excellent	How well does our billing staff address your questions Good	How well does our billing staff address your questions OK	How well does our billing staff address your questions Fair	How well does our billing staff address your questions Poor	How well does our billing staff address your questions N/A
How is your experience with making payment to our office	How is your experience with making payment to our office Excellent	How is your experience with making payment to our office Good	How is your experience with making payment to our office OK	How is your experience with making payment to our office Fair	How is your experience with making payment to our office Poor	How is your experience with making payment to our office N/A

Add additional comments as desired:

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* 13. Overall Experience (select how we are doing in each area)

	Excellent	Good	OK	Fair	Poor	N/A
What is your overall experience with our office	What is your overall experience with our office Excellent	What is your overall experience with our office Good	What is your overall experience with our office OK	What is your overall experience with our office Fair	What is your overall experience with our office Poor	What is your overall experience with our office N/A
How well we keep your personal information private	How well we keep your personal information private Excellent	How well we keep your personal information private Good	How well we keep your personal information private OK	How well we keep your personal information private Fair	How well we keep your personal information private Poor	How well we keep your personal information private N/A
Likelihood that you would refer friends and relative to us for care	Likelihood that you would refer friends and relative to us for care Excellent	Likelihood that you would refer friends and relative to us for care Good	Likelihood that you would refer friends and relative to us for care OK	Likelihood that you would refer friends and relative to us for care Fair	Likelihood that you would refer friends and relative to us for care Poor	Likelihood that you would refer friends and relative to us for care N/A

Preventive Medicine Associates Patient Survey

Question Title

* 1. Your Age:

Question Title

* 2. Select provider at our office you typically see:

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* 3. Your Health

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* 4. Ease of Getting Care (select how we are doing in each area)

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* 5. Visit Experience (select how we are doing in each area)

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* 6. Provider Experience (select how we are doing in each area)

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* 7. Staff Experience (select how we are doing in each area)

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* 8. Telehealth Visits (select most accurate response):

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* 9. Preference Related to Telehealth:

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* 10. Communication (select how we are doing in each area)

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* 11. How do you prefer to receive the following (select all that apply)

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* 12. Financial Experience (select how we are doing in each area)

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* 13. Overall Experience (select how we are doing in each area)

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* 14. What do you like best about our office?

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* 15. Do you have suggestions for improvement?