Please take a few minutes and tell us how we are doing. We appreciate your valuable time and comments. All your responses will be held confidential!   Purpose for visit:   Who brought you to the physician's office? Spouse Friend Parents Public Transportation Relative Myself   Number of people with you: How much time collectively did you spend waiting in the waiting room and examination room? 5 minutes or less 31-45 miutes 6-15 minutes 46 minutes to 1 hour 16- 30 minutes Over an hour   How much time did the physician spend with you? 5 minutes or less 6-15 minutes Over 15 minutes   How would you rate our staff on:   Up-to-date medical procedures Great Fair Very Good Poor Good Not Applicable   Friendliness Great Fair Very Good Poor Good Not Applicable   Patience Great Fair Very Good Poor Good Not Applicable   Responsiveness Great Fair Very Good Poor Good Not Applicable   Empathy Great Fair Very Good Poor Good Not Applicable	Clear Communication Great Fair Very Good Poor Good Not Applicable   Clinical knowledge Great Fair Very Good Poor Good Not Applicable   Do you feel the physician...   Ran or recommended only necessary tests: Disagree Agree   Offered an accurate prognosis: Disagree Agree   Administered caring treatment: Disagree Agree   Would you recommend our medical services to your relatives and friends? Yes Maybe No   What do you consider to be our strengths?   What areas of our medical practice could we improve?   Name   Phone