Summerville Survey English Español Question Title * 1. Please select your provider Brittany O'Toole, FNP Question Title * 2. Do you participate in the sliding scale fee discount plan? Yes No Question Title * 3. If you do participate in the sliding scale plan, do you find your sliding scale fees: Affordable Not affordable Not applicable I do not have sliding scale Question Title * 4. If you do not have insurance and wish to speak with someone about the sliding scale program, please enter in your name and number. Question Title * 5. Insurance Yes No Question Title * 6. Age 0-17 18-35 36-53 54-71 72+ Please select how well you think we are doing. Question Title * 7. EASE OF GETTING CAREScheduling, hours and location Excellent Good Fair Poor Question Title * 8. Scheduling: Friendly, helpful, answered questions. Excellent Good Fair Poor Question Title * 9. FRONT DESKFriendly, helpful, answered questions Excellent Good Fair Poor Question Title * 10. Time spent in the waiting room Excellent Good Fair Poor Question Title * 11. Time spent in the exam room Excellent Good Fair Poor Question Title * 12. STAFFReturn calls, keep you up to date on test results, medications and referrals Excellent Good Fair Poor Question Title * 13. STAFF NURSESFriendly,helpful and answers questions Excellent Good Fair Poor Question Title * 14. PROVIDERListens, takes time, answers questions, provides advice on self-care and treatment options Excellent Good Fair Poor Question Title * 15. PAYMENTCollection of money/payment Excellent Good Fair Poor Question Title * 16. Facility: neat, clean comfort and safety Excellent Good Fair Poor N/A Question Title * 17. Confidentiality:Personal information kept private Excellent Good Fair Poor N/A Question Title * 18. Comments/Suggestions: Question Title * 19. If you were not happy with your office visit and would like to speak to someone about your experience, please enter in your name and number. Question Title * 20. Do you use the patient portal? Yes No I don't know what the patient portal is Question Title * 21. If you do not to use the patient portal, please tell us why: You would rather speak to someone on the phone You do not have a smart phone or computer to access the patient portal Not interested in using it Other Question Title * 22. If you would like help using the patient portal, please leave your name and number and we will reach out to you to assist. Done