Visit Satisfaction Survey Question Title * 1. Overall, how satisfied or dissatisfied were you with your last visit to our office? Very satisfied Somewhat satisfied Neither satisfied nor dissatisfied Somewhat dissatisfied Very dissatisfied Question Title * 2. Overall, how would you rate the service you received from the staff at our office? Excellent Very good Good Fair Poor Question Title * 3. I was offered an appointment that was suitable for my schedule. Strongly agree Agree Neither agree nor disagree Disagree Strongly disagree Question Title * 4. I feel I have adequate access to care with my provider. Strongly agree Agree Somewhat agree Neither agree nor disagree Somewhat disagree Disagree Strongly disagree Question Title * 5. Overall, how would you rate the care you received from your provider? Excellent Very good Good Fair Poor Question Title * 6. How much do you trust your provider to make medical decisions that are in your best interests? A great deal A lot A moderate amount A little Not at all Question Title * 7. My provider listened to my needs & answered my questions. Strongly Agree Agree Somewhat agree or undecided Disagree Strongly Disagree Question Title * 8. My provider explained my treatment options & follow up care. Strongly Agree Agree Somewhat agree or undecided Disagree Strongly disagree Question Title * 9. Overall, I am satisfied with the communication from my provider. Strongly agree Agree Neither agree nor disagree Disagree Strongly disagree Question Title * 10. I would rate my satisfaction with the online patient portal as: Excellent Very good Good Fair Poor Question Title * 11. I received a same day appointment with my complaint. Not applicable (I was seen for a routine reason) True False Question Title * 12. Please share any other comments you have below: Complete and Submit