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Gender:
     
Strongly Disagree
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Disagree
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Neutral
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Agree
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Strongly Agree
5
Unable to Assess
UA
Based on the MOST RECENT VISIT to your doctor
1. Your doctor adequately explained your treatment choices.  
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Based on ALL YOUR VISITS to your doctor's office, how do you feel about your doctor's attitude and behavior towards you? My doctor:

2. Spends enough time with me and shows interest in my problems.  
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5
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3. Asks details about my personal life, when appropriate  
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5
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4. Answers my questions well regarding my office visit.  
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5
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How do you feel that your doctor runs his or her practice?

  Telephone  
5. It is easy to reach the office by phone during the day.  
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  The Staff  
6. Is helpful and
pleasant
 
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7. Is respectful of patients and behaves in a professional manner  
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  Office Practices  
8. I can get an appointment
quickly
 
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9. Someone from my doctor's office follows-up on any serious problems I may have  
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  General  
10. My physician talks to me about preventative care (e.g. quitting smoking, weight control, sleeping, alcohol, exercise, etc.)  
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11. I would go back to this doctor  
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12. I would send a friend to this doctor
 
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