Kittson Memorial Clinic Practitioners and staff would appreciate your comments by completing this anonymous questionnaire. It is only by your feedback that we know whether we are meeting your expectations. Thank you for comments!

* 1. Which Clinic were you seen at?

* 2. Male or Female?

* 3. Your Age?

* 4. Your mailing Zipcode?

* 5. Please check the appropriate option.

  Not Satisfied (1) Some What Satisfied (2) Satisfied (3) Very Satisfied (4) Extremely Satisfied (5) N/A
Were you treated courteously by the staff?
Was the staff attentive to your needs/problems?
Did the practitioner explain the nature of your illness to you in understandable terms?
Was the treatment and health instructions explained clearly?
Did the practitioner allow time to listen and answer your questions?
Do you feel the treatment offered was appropriate to your illness?

* 6. Do you feel the practitioner spent enough time with you?

* 7. Who was the practitioner you saw?

* 8. Would you recommend this practitioner to a friend or family member?

* 9. Will you continue to use this clinic as your source for healthcare?

* 10. How long did you have to wait before being seen by the practitioner?

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