Survey

How friendly/courteous was your care provider? *

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How adequate was explanation about your condition? *

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How much concern for your questions did your care provider show ? *

Very poorPoorFairGoodVery good

How much effort to include you in decisions about your treatment was made by care provider ? *

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Please rate the information your care provider gave about the medication prescribed. *

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Please rate the instruction your care provider gave about your follow-up care. *

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Please rate the amount of time the care provider spent with you. *

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Please rate your confidence in your care provider. *

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On a scale of 1 to 5, how likely would you recommend this care provider ? *

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