How likely is it that you would recommend your doctor to a friend or family member?

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

Not at all likely
Extremely likely
Where did your office visit take place?

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* 2. Where did your office visit take place?

Which provider did you see at our office?

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* 3. Which provider did you see at our office?

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

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

How easy or difficult was it to schedule your appointment with our office?

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* 5. How easy or difficult was it to schedule your appointment with our office?

If you left a message for our office, how timely did we respond to your question/need?

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* 6. If you left a message for our office, how timely did we respond to your question/need?

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

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

How comfortable and presentable was the lobby and waiting area?

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* 8. How comfortable and presentable was the lobby and waiting area?

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

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

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

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

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

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

How well did your provider listen to your needs?

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

How well did your provider answer your questions?

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

How well did your provider explain your treatment options?

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

How well did your provider explain your follow-up care?

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

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

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

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

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

What is your name (optional) - please include if you have left comments that might require our feedback/response?

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* 18. What is your name (optional) - please include if you have left comments that might require our feedback/response?

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