Your feedback is important to us!

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* 1. Who is your Primary Care Provider (PCP)?

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* 2. What type of insurance do you have?

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* 3. Do you know what to do if you need care outside of our regular office hours?

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* 4. Do you feel our hours of operation are convenient?

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* 5. How would you estimate the amount of time you waited during your visit?

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* 6. Did the office staff keep you informed if your appointment was going to be delayed?

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* 7. When you made this appointment, were you able to get an appointment on the day you asked for?

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* 8. Did you see the doctor that you wanted to see today?

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* 9. Are your prescription refill requests completed in a timely manner?

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* 10. At your most recent office visit, how were you treated by the administration staff?

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* 11. At your most recent visit, how were you treated by the nursing staff?

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* 12. If you had an appointment with a physician or a nurse practitioner, did you feel they spent enough time with you?

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* 13. If you had an appointment with a physician or a nurse practitioner, did they explain things in a way that was easy to understand?

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* 14. If you had an appointment with a physician or a nurse practitioner, did you feel that they listened and respected you as a partner in your care?

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* 15. In the last 12 months, when your healthcare provider ordered a blood test, x-ray, or other test for you, how often did someone from our office follow up to give you those results?

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* 16. If you had an appointment with a physician or a nurse practitioner, did they talk with you about specific goals for your health?

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* 17. When you are referred to another physician or specialist, do you feel informed about the next step?

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* 18. During your most recent visit, did your healthcare provider seem to know the important information about your medical history?

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* 19. Would you be interested in participating in our focus group?

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* 20. Is there anything else you would like to tell us?

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