We Want Your Feedback

Please tell us about your experiences with your personal doctor and the office staff. Answer all questions in the survey. The information you provide is completely confidential.

Your Health Experience
In the last 6 months:NeverSometimesUsuallyAlwaysN/A
When you have needed care (routine, right away, or check-up), how often did you get it as soon as you thought you needed?
Wait time includes time spent in the waiting room and exam room. How often did you see the person you came to see within 15 minutes of your appointment time?
How often was it easy to get the care, test, or treatment you needed?
When you visited your personal doctor for a scheduled appointment, how often did he or she have your medical records or other information about your care?
When your personal doctor ordered a blood test, x-ray, or other test for you, how often did someone from your personal doctor's office follow up to give you those results?
When your personal doctor ordered a blood test, x-ray, or other test for you, how often did you  get those results as soon as you needed them?
How often did you and your personal doctor talk about all the prescription medications you were taking?
How often do you take your medications as prescribed by your doctor?
Did you get the help you needed from your personal doctor's office to manage your care among the different providers and services?
How often did your personal doctor seem informed and up-to-date about the care you got from specialist?
Your Overall Experience
TopicsWorst Possible- 0123456789Best Possible- 10
Based on your experience with your personal doctor, what rating would you give this doctor?
Based on your experience with the office staff, wat rating would you give them?
What number would you use to rate all your health care in the last 6 months?
Your Health Questions- Physical Activity
TopicsYesNoI had no visits in the past 12 months
In the past 12 months, did you talk with a doctor or other health provider about your level of exercise or physical activity? For example, a doctor or other health provider may ask you if you exercise regularly or take part in physical exercise.
In the past 12 months, did a doctor or other health provider advise you to start, increase or maintain your level of exercise or physical activity? For example, in order to improve your health, your doctor or other health provider may advise you to start taking the stairs, increase walking from 10 to 20 minutes everyday or to maintain your current exercise program.
Your Health Questions- Fall Risk Prevention
TopicsYesNoI had no visits in the past 12 months
In the past 12 months, did you talk with your doctor or other health provider about falling or problems with balance or walking?
In the past 12 months, have you had a problem with balance or walking?
Has your doctor or other health provider done anything to help prevent falls or treat problems with balance or walking? Some things they might do include: suggest you use a cone or walker, check your blood pressure lying or standing, suggest you do an exercise or physical therapy program, or suggest a vision or hearing test.
Your Health Questions- Bladder Control
TopicsYesNoI had no visits in the past 12 months
Many people experience leakage or urine, also called urinary incontinence. In the past 6 months, have you experienced leaking of urine?
There are many ways to control or manage the leaking of urine, including bladder training exercises, medication, and surgery. Have you ever talked with a doctor, nurse, or other healthcare provider about any of these approaches?
Your Health Questions- Flu Vaccine
TopicsYesNoDon't Know
Have you had the flu shot since July 1, 2020?
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