Exit this survey Physician Performance Evaluation Template Question Title * 1. How likely are you to recommend your doctor to family or friends? Extremely likely Very likely Moderately likely Slightly likely Not at all likely Question Title * 2. During a typical office visit, does your doctor spend too much time with you, too little time with you, or about the right amount of time with you? Much too much Somewhat too much Slightly too much About the right amount Slightly too little Somewhat too little Much too little Question Title * 3. How much do you trust your doctor to make medical decisions that are in your best interests? A great deal A lot A moderate amount A little Not at all Question Title * 4. How helpful is your doctor at explaining your medical condition(s)? Extremely helpful Very helpful Moderately helpful Slightly helpful Not at all helpful Question Title * 5. How quickly does your doctor's staff help you when you need help? Extremely quickly Very quickly Moderately quickly Slightly quickly Not at all quickly Question Title * 6. How friendly is your doctor's office staff? Extremely friendly Very friendly Moderately friendly Slightly friendly Not at all friendly Question Title * 7. How knowledgeable is your doctor's office staff? Extremely knowledgeable Very knowledgeable Moderately knowledgeable Slightly knowledgeable Not at all knowledgeable Question Title * 8. How easy is it to get to your doctor's office? Extremely easy Very easy Moderately easy Slightly easy Not at all easy Question Title * 9. How easy is it to schedule urgent appointments with your doctor when you're ill? Extremely easy Very easy Moderately easy Slightly easy Not at all easy Question Title * 10. Overall, are you satisfied with your doctor, neither satisfied nor dissatisfied with him/her, or dissatisfied with him/her? Extremely satisfied Very satisfied Moderately satisfied Neither satisfied nor dissatisfied Moderately dissatisfied Very dissatisfied Extremely dissatisfied Question Title * 11. How well does your doctor listen to you? Extremely well Very well Moderately well Slightly well Not at all well Question Title * 12. How well does your doctor answer your questions? Extremely well Very well Moderately well Slightly well Not at all well Question Title * 13. How well does your doctor explain how to take your medicine(s)? Extremely well Very well Moderately well Slightly well Not at all well Done