1. How would you rate your satisfaction with getting through to the office by phone?

Excellent
Very Good
Good
Fair
Poor

2. How would you rate your satisfaction with the length of time you waited to get your appointment?

Excellent
Very Good
Good
Fair
Poor

3. Did you see the clinician or staff member you wanted to see?

Yes
No
Did not matter who I saw.

4. How would you rate your satisfaction with the personal manner of the person you saw (courtesy, respect, sensitivity, friendliness)?

Excellent
Very Good
Good
Fair
Poor

5. How would you rate your satisfaction with the time spent with the person you saw?

Excellent
Very Good
Good
Fair
Poor