Survey

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* 1. Our records show that you got care from Dr. Wheeler. Is that right?

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* 2. How long have you been going to Dr. Wheeler?

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* 3. In the last 12 months, how many times did you visit Dr. Wheeler?

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* 4. In the last 12 months, did you phone Dr. Wheeler’s office to get an appointment for an illness, injury, or condition that needed care right away?

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* 5. How long has it been since your most recent visit with Dr. Wheeler?

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* 6. Wait time includes time spent in the waiting room and exam room. During your most recent visit, did you see Dr. Wheeler within 15 minutes of your appointment time?

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* 7. During your most recent visit, did Dr. Wheeler explain things in a way that was easy to understand?

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* 8. During your most recent visit, did you talk with Dr. Wheeler about any health questions or concerns?

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* 9. During your most recent visit, did Dr. Wheeler give you easy to understand information about these health questions or concerns?

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* 10. During your most recent visit, did Dr. Wheeler seem to know the important information about your medical history?

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* 11. During your most recent visit, did Dr. Wheeler spend enough time with you?

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* 12. Using any number from 0 to 10, where 0 is the worst provider possible and 10 is the best provider possible, what number would you use to rate Dr. Wheeler?

  10 Best provider possible 9 8 7 6 5 4 3 2 1 0 Worst provider possible
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* 13. Using any number from 0 to 10, where 0 is NOT very knowledgable and 10 is very knowledgable, what number would you use to rate Dr. Wheeler's knowledge about your condition?

  10 Best provider possible 9 8 7 6 5 4 3 2 1 0 Worst provider possible
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* 14. Using any number from 0 to 10, where 0 is the worst staff possible and 10 is the best staff possible, what number would you use to rate Dr. Wheeler's Staff?

  10 Best provider possible 9 8 7 6 5 4 3 2 1 0 Worst provider possible
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* 15. Would you recommend Dr. Wheeler’s office to your family and friends?

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