* 1. What is the name of the practitioner you saw today?

* 2. Overall, how would you rate your visit?

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

* 4. Did our staff meet your needs?

* 5. Were you able to be seen as quickly as you needed?

* 6. Would you recommend your healthcare provider’s office to your family and friends?