GAP Patient Survey

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* 1. How long have you been a patient of any GAP location?

I am a new patient (this was my first visit)

Less than 1 year

1-5 years

6-10 years

More than 10 years

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* 2. In the last 12 months, how many times did you visit one of our facilities? (Includes Piedmont, Salem, Clemmons, and both endoscopy centers.)

1 time

2-3 times

4-5 times

6-9 times

10 or more times

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* 3. Which location do you typically visit?

Winston-Salem

Kernersville

Clemmons

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* 4. Which provider(s) do you normally see?

Dr. Austin

Dr. Barry

Dr. Cengia

Dr. Connolley

Dr. Cornella

Dr. Holmes

Dr. Jones

Dr. McKimmie

Dr. Mixon

Dr. Murphy

Dr. Patwa

Dr. Peters

Dr. Scott

Dr. Smith

Dr. Sweeney

Ayako Allen, NP-C

Paul Gregory, NP-C

Christa Hubert, PA-C

Kari McChesney, NP-C

Kim Ray, PA-C

Ashley Schmidt, NP-C

Chi Shatalov, PA-C

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* 5. What is your age?

16-25

26-35

36-49

50-64

65 or older

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* 6. Do you use MyChart to communicate with our staff?

Yes

I don't know what MyChart is

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* 7. How did you hear about us?

Friend, family member, or colleague

Referred by a physician

Community event

Phonebook

Internet

Other (please specify)

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* 8. Would you recommend GAP to a friend, family member, or colleague?

Yes

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* 9. What obstacles might keep you from receiving proper care with us?

Access to transportation

Distance from home

Financial/Insurance

Language barrier

Health status due to age

Health status due to mental/physical disability

Chronic illness

Not applicable to me

Other (please specify)

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* 10. In the last 12 months, how often have you been able to receive routine, urgent and after-hours care from us when you needed it?

Never

Sometimes

Usually

Always

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* 11. In the last 12 months when you called with a question, how often did you get an answer that same day?

Never

Sometimes

Usually

Always

I haven't called with a question

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* 12. In the last 12 months when blood work, procedures or other tests were ordered for you, how often did someone from GAP follow-up within 10 business days to give you those results?

Never

Sometimes

Usually

I haven't had any testing done

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* 13. In the last 12 months, how often do you feel that you were given enough information about managing your health?

Never

Sometimes

Usually

Always

I haven't had any health conditions that need managing

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* 14. In the last 12 months, how often did you feel that the providers and staff listened to, respected, and took the necessary time to answer your questions?

Never

Sometimes

Usually

Always

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* 15. In the last 12 months, how often did you feel that GAP providers have sufficiently communicated your care with your primary care physician?

Never

Sometimes

Usually

Always

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* 1. How long have you been a patient of any GAP location?

Question Title

* 2. In the last 12 months, how many times did you visit one of our facilities? (Includes Piedmont, Salem, Clemmons, and both endoscopy centers.)

Question Title

* 3. Which location do you typically visit?

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* 4. Which provider(s) do you normally see?

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* 5. What is your age?

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* 6. Do you use MyChart to communicate with our staff?

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* 7. How did you hear about us?

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* 8. Would you recommend GAP to a friend, family member, or colleague?

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* 9. What obstacles might keep you from receiving proper care with us?

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* 10. In the last 12 months, how often have you been able to receive routine, urgent and after-hours care from us when you needed it?

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* 11. In the last 12 months when you called with a question, how often did you get an answer that same day?

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* 12. In the last 12 months when blood work, procedures or other tests were ordered for you, how often did someone from GAP follow-up within 10 business days to give you those results?

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* 13. In the last 12 months, how often do you feel that you were given enough information about managing your health?

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* 14. In the last 12 months, how often did you feel that the providers and staff listened to, respected, and took the necessary time to answer your questions?

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* 15. In the last 12 months, how often did you feel that GAP providers have sufficiently communicated your care with your primary care physician?

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* 16. Please enter any comments or suggestions here.