1. How likely is it that you would recommend your provider to a friend or family member?*0123456789102. Overall, how satisfied or dissatisfied were you with your last visit to our Clinic?*Very SatisfiedSomewhat dissatisfiedSomewhat satisfiedVery dissatisfiedNeither satisfied nor dissatisfied3. How easy or difficult was it to schedule your appointment at a time that was convenient for you?*Very easySomewhat difficultSomewhat easyVery difficultNeither easy nor difficult4. How convenient was the appointment time you were able to get?*Extremely convenientNot so convenientVery convenientNot at all convenientSomewhat convenient5. In your opinion, how convenient is the location of our Clinic?*Extremely convenientNot so convenientVery convenientNot at all convenientSomewhat convenient6. Overall, how would you rate the service you received from the staff at our clinic?*ExcellentFairVery goodPoorGood7. How comfortable was the lobby and waiting area?*Extremely comfortableNot so comfortableVery comfortableNot at all comfortableSomewhat comfortable8. Did your appointment with your provider start early, late or on time?*Very earlySomewhat lateSomewhat earlyVery lateOn time9. Overall, how would you rate the care you received from your provider?*ExcellentFairVery goodPoorGood10. How much do you trust your provider to make medical decisions that are in your best interests?*A great dealA littleA lotNot at allA moderate amount11. How well did your provider listen to your needs?*Extremely wellNot so wellVery wellNot at all wellSomewhat well12. How well did your provider answer your questions?*Extremely wellNot so wellVery wellNot at all wellSomewhat well13. How well did your provider explain your treatment options?*Extremely wellNot so wellVery wellNot at all wellSomewhat well14. How well did your provider explain your follow-up care?*Extremely wellNot so wellVery wellNot at all wellSomewhat well15. How satisfied or dissatisfied were you with the amount of time your provider spent with you addressing your needs?*Very satisfiedSomewhat dissatisfiedSomewhat satisfiedVery dissatisfiedNeither satisfied nor dissatisfied16. Is there anything we could have done to improve your last visit?*