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* 1. The last time you were sick or had a health problem, were you able to obtain an appointment on the DATE you requested?

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* 2. The last time you had an urgent need (did not go to the ER, but needed care within 24 hours), were you offered a same day, or next day appointment?

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* 3. When you see your physician or a nurse practitioner, how often do they, or someone else in the clinic, involve you as much as you want to be involved in the decisions about your care and treatment?

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* 4. Do you feel comfortable and welcome at this clinic?

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* 5. Check all that apply:

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* 6. When you book an appointment online, do you feel there is enough choices to accommodate your needs?

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* 7. When you visit the clinic, are the waiting room times satisfactory?

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