Please select your Provider Office/Name below:^*

In last 6 months, you got an appointment for a checkup for routine care as soon as you needed^*

In last 6 months, when you needed care right away (urgent), you got care as soon as you needed^*

Efficiency of the check-in process^*

You were able to see your provider within 15 minutes of your appointment time^*

Relevance of our educational materials^*

Your ability to contact us after hours^*

Your phone calls were answered promptly^*

Your test results were reported in a reasonable amount of time or as soon as needed^*

Convenient hours of operation^*

Easy to follow signage and directions^*

Convenient parking^*

Doctor explanations are easy to understand^*

Ease of getting care, tests or treatment through your provider.^*

Doctor listens carefully and spends enough time with you^*

Doctor explained the importance of getting an annual flu shot^*

Instructions given regarding medication/follow-up care^*

Doctor knew important information about your medical care and care provided by your specialists^*

Doctor asked if you felt depressed and talked about things that cause stress^*

Doctor talked about your balance and any falls in the past 12 months^*

Doctor talked about all your medications and explained why you take them^*

Ease of getting appointments with specialists^*

Courtesy of the person who took your call^*

Friendliness of receptionist upon your arrival^*

You received help, if needed, to manage your care with other doctors^*

How satisfied are you with the referral process?^*

If you’ve had a referral denied, how satisfied were you with the reason behind the denial?^*