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Rate Your Doctor Visit
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What overall rating would you give your recent visit to our office?  Poor;   Fair;   Good;   Very Good;   Excellent;  *
Please rate the ease of scheduling urgent appointments.  Poor;   Fair;   Good;   Very Good;   Excellent;  
Please rate our office environment - cleanliness, comfort and location:  Poor;   Fair;   Good;   Very Good;   Excellent;  
Please rate our friendliness and courteousness.  Poor;   Fair;   Good;   Very Good;   Excellent;  
How long did you wait for your appointment?  0-5 minutes;   5-10 minutes;   10-15 minutes;   15-20 minutes;   20 minutes or longer;  
Did your physician spend an appropriate amount of time with you?  Definitely Not;   Mostly Not;   Not Sure;   Mostly Yes;   Definitely Yes;  
Did your physician listen to you and answer your questions?  Definitely Not;   Mostly Not;   Not Sure;   Mostly Yes;   Definitely Yes;  
Did your physician help you understand your medical condition?  Definitely Not;   Mostly Not;   Not Sure;   Mostly Yes;   Definitely Yes;  
Do you feel your physician made decisions or recommendations that were in your best interest?  Definitely Not;   Mostly Not;   Not Sure;   Mostly Yes;   Definitely Yes;  
Would you recommend your physician to family and friends?  Definitely Not;   Mostly Not;   Not Sure;   Mostly Yes;   Definitely Yes;  
Please share any additional comments you may have about your recent doctor visit.
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