APPOINTMENTS

* 1. Our records show that you have received care from Theodore Medical. Is that right?

* 2. Is Theodore Medical, the provider you usually use when you need a check-up, want advice about a health problem, or get sick or hurt?

* 3. How long have you been coming to Theodore Medical?

* 4. In the last 12 months, how many times did you visit Theodore Medical?

* 5. How long has it been since your most recent visit with Theodore Medical?

* 6. In the last 12 months, did you phone Theodore Medical to get an appointment for an illness, injury, or condition that needed care right away?

* 7. In the last 12 months, when you phoned Theodore Medical to get an appointment for care you needed right away, how often did you get an appointment as soon as you needed?

* 8. If so, did you get an appointment:

* 9. In the last 12 months, did you make any appointments for a check-up or routine care with Theodore Medical?

* 10. In the last 12 months, when you made an appointment for a check-up or routine care with Theodore Medical, how often did you get an appointment as soon as you needed?

* 11. When did you have the appointment made:

* 12. Wait time includes time spent in the waiting room and exam room. In the last 12 months, how often did you see the doctor at Theodore Medical within 15 minutes of your appointment time?

* 13. Wait time includes time spent in the waiting room and exam room. In the last 12 months, how often did you see the doctor at Theodore Medical within 15 minutes of your notified time (if delayed) ?

* 14. In the last 12 months, if your appointment was delayed, how often did Theodore Medical keep you adequately informed?

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