* 1. How likely is it that you would recommend your provider to a friend or family member?

Not at all likely
Extremely likely

* 2. Overall, how satisfied or dissatisfied were you with your last visit to our office?

* 3. How convenient was the appointment time you were able to get?

* 4. Overall, how would you rate the care you received from your provider?

* 5. How much do you trust your provider to make medical decisions that are in your best interests?

* 6. How well did your provider listen to your needs?

* 7. How well did your provider answer your questions?

* 8. How well did your provider explain your treatment options?

* 9. How well did your provider explain your follow-up care?

* 10. Is there anything we could have done to improve your last visit?

T