Post-Visit Patient Survey How was your care at MCHWC, Bayview Clinic or the Birth Center? Question Title * 1. When was your appointment? Please enter date in one of the spaces below, as appropriate. Morning appointment on: Date Afternoon appointment on: Date Question Title * 2. Who was your provider at your last appointment? Dr. Blomquist, MD Dr. Campbell, DDS Dr. Hall, DDS Dr. Leary, PsyD (Karuna) Dr. Park, DDS Colin Spake, NP Danielle Jackson, PA Shannon Wozniak, PNP Deborah Spake, MFT Kiki Jordan, LM (midwife) Dr. Daniel Smith (chiropractor) Dr. Galbraith, MD Alaina Pirie, NP Namuun Clifford, NP Catherine Ewing, LCSW (social worker) Dr. Fotadar, DDS Dr. French, MD Dr. Mayorga, DDS Dr. Thompson, PsyD Yunji Yoon, PNP Question Title * 3. Where did your visit take place? Marin City Center Point (San Rafael) Bayview Hunters Point (SF) Marin Family Birth Center (Northgate) Question Title * 4. Was your appointment on time? My appointment started within 5 minutes of the scheduled time My provider was 5-15 minutes late My provider was more than 15 minutes late Other (please specify): Question Title * 5. Did you receive the care you needed? Yes No Other (please specify): Question Title * 6. The other staff who helped me (receptionist, front desk, medical assistants) were: Very Somewhat Fair Not very Not at all Friendly Friendly Very Friendly Somewhat Friendly Fair Friendly Not very Friendly Not at all Knowledgeable Knowledgeable Very Knowledgeable Somewhat Knowledgeable Fair Knowledgeable Not very Knowledgeable Not at all Question Title * 7. Would you return to see the same provider? Yes No Question Title * 8. Is there anything else we can do to provide you with better care? Question Title * 9. Your name (optional) Done