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* 1. Please rate your overall experience using Health Services.

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* 2. Were you treated courteously by staff?

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* 3. Were staff members attentive to your needs/problems?

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* 4. Did the clinician (RN/Nurse Practitioner/Medical Doctor) explain the nature of your illness/problem in understandable terms?

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* 5. Were the treatment and health instructions explained clearly? 

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* 6. Did the clinician allow time to listen to and answer your questions? 

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* 7. Were you satisfied with how your problem was addressed? 

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* 8. Were you satisfied with the treatment offered to assist you with your problem?

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* 9. Were you satisfied with the amount of time spent with you? 

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* 10. Do you have other comments, questions, or concerns?

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