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

NOT AT ALL LIKELY
EXTREMELY LIKELY

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

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* 3. How easy or difficult was it to schedule your appointment at a time that was convenient for you?

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

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* 5. In your opinion, how convenient is the location of our office?

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* 6. Overall, how would you rate the service you received from the staff at our office?

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* 7. How comfortable was the lobby and waiting area?

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* 8. Did your appointment with your provider start early, late or on time?

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

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

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

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

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

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

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* 15. Do you feel your overall wellness is considered and addressed in the decision-making process during your visit? (Overall wellness includes mental, emotional, physical, and spiritual health.)

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* 16. How satisfied or dissatisfied were you with the amount of time your provider spent with you addressing your needs?

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* 17. Which provider did you see at your most recent office visit?

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* 18. For your most recent visit, were you seen in the office or via Telemedicine?

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* 19. If you were seen via telemedicine, how likely are you to use this visit method again? 

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* 20. Do you feel it would be beneficial for our clinic to offer appointments after 5pm?

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* 21. Do you feel if would be beneficial for the clinic to offer weekend appointments? 

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* 22. Are there any additional services you would like to see offered at Ironwood Family Practice? 

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

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* 24. Please select your age group below. 

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* 25. Please select your legal gender below. 

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