This is a confidential survey.  Please take a moment to tell us about your experience.  

* 1. At which Charlotte Heart and Vascular location were you seen?

* 2. Which Physician or Physician Assistant did you see at Charlotte Heart and Vascular?

* 3. In the last 12 months, if you phoned Charlotte Heart and Vascular’s office to get an appointment for care you needed right away, how often did you get an appointment as soon as you needed?

* 4. In the last 12 months, if you made an appointment for a check-up or routine care with Charlotte Heart and Vascular, how often did you get an appointment as soon as you needed?

* 5. In the last 12 months, if you phoned Charlotte Heart and Vascular’s office during regular office hours, how often did you get an answer to your medical question that same day?

* 6. In the last 12 months, if you phoned Charlotte Heart and Vascular’s office after regular office hours, how often did you get an answer to your medical question as soon as you needed?

* 7. Wait time includes time spent in the waiting room and exam room. In the last 12 months, how often did you see Charlotte Heart and Vascular within 15 minutes of your appointment time?

* 8. During your most recent visit, did your healthcare provider explain things in a way that was easy to understand?

* 9. During your most recent visit, did your healthcare provider listen carefully to you?

* 10. During your most recent visit, did your healthcare provider give you easy to understand information about your health questions or concerns?

* 11. During your most recent visit, did your healthcare provider seem to know the important information about your medical history?

* 12. During your most recent visit, did your healthcare provider show respect for what you had to say?

* 13. During your most recent visit, did your healthcare provider spend enough time with you?

* 14. During your most recent visit, did your healthcare provider order a blood test, x-ray, or other test for you?

* 15. Did someone from Charlotte Heart and Vascular’s office follow up to give you those results?

* 16. Using any number from 0 to 10, where 0 is the worst provider possible and 10 is the best provider possible, what number would you use to rate Charlotte Heart and Vascular?

  10 Best provider possible 9 8 7 6 5 4 3 2 1 0 Worst provider possible
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* 17. Would you recommend Charlotte Heart and Vascular’s office to your family and friends?

* 18. During your most recent visit, were clerks and receptionists at Charlotte Heart and Vascular’s office as helpful as you thought they should be?

* 19. During your most recent visit, did clerks and receptionists at Charlotte Heart and Vascular’s office treat you with courtesy and respect?

* 20. Do you have any other comments, questions, or concerns?

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