* 1. I had an appointment with:

* 2. Ability to get through to the office by phone.

* 3. The time between your call to schedule an appointment and your appointment date.

* 4. The manners of the person(s) who scheduled your appointment.

* 5. Clarity of directions to the office and instructions for date and time of your appointment.

* 6. The professionalism and helpfulness of our check-in staff.

* 7. Your wait time in the lobby.

* 8. The comfort and cleanliness of the reception area.

* 9. Your wait time in the exam room.

* 10. The comfort and cleanliness of the clinical area.

* 11. The extent to which staff respected your privacy.

* 12. Your physician's or physician assistant's listening skills. 

* 13. His/her explanation of procedures, diagnoses or treatment regimen.

* 14. His/her personal manner (respect, sensitivity, friendliness).

* 15. The preparedness of the staff and physician or physician assistant for your visit.

* 16. My physician or physician assistant spent adequate time with me.

* 17. I clearly understand the next steps in my plan of care.

* 18. The educational information I received was helpful.

* 19. I would return to see this physician or physician assistant for further care.

* 20. Other staff's personal manner (courtesy, respect, sensitivity, friendliness).

* 21. The service/care provided was valuable to improving my health.

* 22. I received test results in a timely manner following my office visit or procedure.

* 23. I would recommend this practice to family and friends.

* 24. Did a certain staff member go above and beyond for you today?

* 25. If so, please share your story.

* 26. Any additional comments/concerns that you would like to share with us?

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