* 1. Which provider did you see today?

* 2. Main Reason for your visit today:

* 3. In this practice, 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 visit today, how acceptable was the wait time before you saw the provider? 

* 7. During your visit today, how acceptable was the time the provider spent with you? How well 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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