1. How likely is it that you would recommend your provider to a friend or family member?*

2. Overall, how satisfied or dissatisfied were you with your last visit to our Clinic?*

3. How easy or difficult was it to schedule your appointment at a time that was convenient for you?*

4. How convenient was the appointment time you were able to get?*

5. In your opinion, how convenient is the location of our Clinic?*

6. Overall, how would you rate the service you received from the staff at our clinic?*

7. How comfortable was the lobby and waiting area?*

8. Did your appointment with your provider start early, late or on time?*

9. Overall, how would you rate the care you received from your provider?*

10. How much do you trust your provider to make medical decisions that are in your best interests?*

11. How well did your provider listen to your needs?*

12. How well did your provider answer your questions?*

13. How well did your provider explain your treatment options?*

14. How well did your provider explain your follow-up care?*

15. How satisfied or dissatisfied were you with the amount of time your provider spent with you addressing your needs?*

16. Is there anything we could have done to improve your last visit?*

Patient Feedback