Satisfaction Survey The following survey is designed to help us improve our quality of care based on your feedback. If there are areas in which you think we could improve, we want to know about it! Your satisfaction is very important to us and we appreciate you taking a couple minutes to complete the form below! OK Question Title * 1. Where did you receive care today? OK Question Title * 2. Which care provider did you see today? OK Question Title * 3. What is your age? 0-12 13-19 20-29 30-39 40-49 50-64 65+ OK Question Title * 4. Do you consider yourself Hispanic or Latino Yes, Hispanic or Latino No, not Hispanic or Latino OK Question Title * 5. Please rate your ability to get appointments for check-ups, yearly exams, well visits, regular follow-up visits? Very Good Good Fair Poor OK Question Title * 6. Please rate your ability to get appointments when you're sick Very good Good Fair Poor OK Question Title * 7. Please rate our staff's ability to answer your questions in a way that you could understand Very good Good Fair Poor OK Question Title * 8. Did someone talk to you about your health goals during your visit? Yes. No. I don't know. OK Question Title * 9. Did someone ask you if there was a period of time when you felt sad or depressed? Yes. No. I don't know. OK Question Title * 10. Overall, please rate your satisfaction with the care you received. Very good Good Fair Poor. OK Question Title * 11. Is there anything else you think we should know about your experience at our practice? OK SUBMIT!