Please take a moment and help us continue to improve our medical care by completing this survey about your medical office visit

Medical Clinic You Visited * Your Age Do You have your own transportation to our facility ? Is English your first Language? Are you currently or permanently disabled? Do You Live Alone? Do you require assistance with taking your medications? How many minutes did your wait after your scheduled appointment before you were called to the exam room? How many minutes did you wait in the exam room before your seen by the provider?

For next questions 1= very poor 2= poor 3= fair 4 = good 5 = very good N/A is not applicable

Ease of Scheduling Your Appointment Ability to get appointment for desired time Courtesy of person who scheduled your appointment Our Helpfulness on the telephone Our Promptness in returning your phone calls Speed of Registration Process Courtesy of staff in the registration process Length of wait before getting to exam room Comfort and pleasantness of the exam room Friendliness Courtesy of the nurse Concern the nurse showed for you Waiting time in exam room before being seen Friendliness Courtesy of the provider Explanations the care provider gave you about your condition Ease of obtaining test results Concern the care provider gave you about your condition Provider's efforts to include you in decisions about your treatment Information the provider gave you about medications Instructions the care provider gave you about follow-up care Degree to which care provider use words you could understand Amount of time care provider spent with you Your confidence in this care provider Likelihood of you recommending this care provider to others Convenience of our office hours Our Sensitivity to your needs Our concern for your privacy Overall cheerfulness of our practice Overall cleanliness of our practice Overall Rating of care received during your visit Likelihood of you recommending our practice to others Thank you. Please include any other comments