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

* 2. Were you treated courteously by staff?

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

* 4. Did the clinician (nurse/nurse practitioner/doctor) explain the nature of your illness/problem in understandable terms?

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

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

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

* 8. How satisfied were you with the treatment offered to assist you with your problem?<o:p></o:p>

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

* 10. Please comment to help support your answers and provide suggestions to improve the program. If you had a negative experience, please feel free to specify with whom.:

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