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

* 2. What was the reason for your most recent visit?

* 3. When I phone to get an appointment for care I need right away, I am able to get an appointment as soon as I feel I need one.

* 4. When I phone the office after regular office hours, I get an answer to my medical question as soon as I need it.

* 5. I believe my doctor and the office staff have a commitment to provide the quality care and support that I need.  I feel that the staff members treat me with respect and care. 

* 6. During your most recent visit, how acceptable was the wait time before you saw the provider?

* 7. During your most recent visit, how acceptable was the time your provider spent with you? Did the doctor listen to your concerns? And were instructions clear and easy to understand?

* 8. How would you rate your overall experience today?

* 9. How likely are you to recommend this office to your family and friends?

* 10. Please tell us about anything we do well AND how we can improve the care and services we offer:

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