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* 1. Please tell us the department/area you last visited at BID-Plymouth

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* 2. Was this your first visit to that area?

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* 3. What time was your appointment scheduled if known?

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* 4. What is your age:

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* 5. For the following questions, please rate your experience on a scale of 1-5. If a question does not apply, please skip to the next question.

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* 6. Helpfulness of registration personnel

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* 7. Ease of registration/check-in/scheduling process

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* 8. Comfort of the waiting area

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* 9. Comfort of the exam room

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* 10. Cleanliness of the surroundings

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* 11. Staff's level of professionalism when providing your test or treatment

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* 12. How well staff worked as a team to provide care

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* 13. Staff's sensitivity to your expressed needs

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* 14. Overall rating of the care you received

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* 15. How helpful was the education provided to you?

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* 16. Patient's name and telephone number: (optional)

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* 17. Comments

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