Sarasota Vascular Specialist Customer Survey Patient Engagement Question Title * 1. Did you recently receive care from one of our surgeons? Yes No Question Title * 2. Is your surgeon, the provider you usually see if you need an annual check up for any vascular work you received? Yes No Question Title * 3. How long have you been going to your surgeon? Less than 6 months At least 6 months but less than 1 year At least 1 year but less than 3 years At least 3 years but less than 5 years 5 years or more Question Title * 4. In the last 12 months, how many times did you visit your surgeon? None 1 time 2 3 4 5 to 9 10 or more times Question Title * 5. In the last 12 months, did you phone your surgeon’s office to get an appointment for a condition that needed care right away? Yes No Question Title * 6. In the last 12 months, when you phoned your surgeon’s office to get an appointment for care you needed right away, how often did you get an appointment as soon as you needed? Never Sometimes Usually Always Question Title * 7. In the last 12 months, did you make any appointments for a check-up or routine care with your surgeon? Yes No Question Title * 8. In the last 12 months, when you made an appointment for a check-up or routine care with your surgeon, how often did you get an appointment as soon as you needed? Never Sometimes Usually Always Question Title * 9. In the last 12 months, did you phone your surgeon’s office with a medical question during regular office hours? Yes No Question Title * 10. In the last 12 months, when you phoned your surgeons nurse during regular office hours, how often did you get an answer to your medical question that same day? Never Sometimes Usually Always Question Title * 11. In the last 12 months, did you phone your surgeon's nurse with a medical question after regular office hours? Yes No Question Title * 12. In the last 12 months, when you phoned your surgeon’s office after regular office hours, how often did you get an answer to your medical question as soon as you needed? Never Sometimes Usually Always Question Title * 13. Wait time includes time spent in the waiting room, ultrasound, and exam room. In the last 12 months, how often did you see your surgeon within 30 minutes of your appointment time? Never Sometimes Usually Always Question Title * 14. In the last 12 months, how often did your surgeon explain things in a way that was easy to understand? Never Sometimes Usually Always Question Title * 15. In the last 12 months, how often did your surgeon listen carefully to you? Never Sometimes Usually Always Question Title * 16. In the last 12 months, how often did your surgeon give you easy to understand information about these health questions or concerns? Never Sometimes Usually Always Question Title * 17. In the last 12 months, how often did your surgeon seem to know the important information about your medical history? Never Sometimes Usually Always Question Title * 18. In the last 12 months, how often did your surgeon show respect for what you had to say? Never Sometimes Usually Always Question Title * 19. In the last 12 months, how often did your surgeon spend enough time with you? Never Sometimes Usually Always Question Title * 20. In the last 12 months, did your surgeon order a blood test, x-ray, or other test for you? Yes No Question Title * 21. In the last 12 months, when your surgeon ordered a blood test, x-ray, or other test for you, how often did someone from this provider’s office follow up to give you those results? Never Sometimes Usually Always Question Title * 22. Using any number from 0 to 10, where 0 is the worst provider possible and 10 is the best provider possible, what number would you use to rate your surgeon? 10 Best provider possible 9 8 7 6 5 4 3 2 1 0 Worst provider possible . . 10 Best provider possible . 9 . 8 . 7 . 6 . 5 . 4 . 3 . 2 . 1 . 0 Worst provider possible Question Title * 23. In the last 12 months, how often were receptionists at your surgeon's office as helpful as you thought they should be? Never Sometimes Usually Always Question Title * 24. In the last 12 months, how often did receptionists at your surgeon's office treat you with courtesy and respect? Never Sometimes Usually Always Question Title * 25. In general, how would you rate your overall health? Excellent Very good Good Fair Poor Question Title * 26. What is your age? 18 to 24 25 to 34 35 to 44 45 to 54 55 to 64 65 to 74 75 or older Question Title * 27. Are you male or female? Male Female Question Title * 28. Which surgeon did you see today? Dr. Dorsay Dr. Hershberger Dr. Lepore Dr. Nair Dr. Samson Dr. Parrack Dr. Wagner Done