Your Input is Valuable
What location was your last appointment at?
103 Allen Street
31 Sherman Street
95 E Chautauqua Street
Is the office able to schedule an appointment when you want or need one?
Yes
No
Did this office tell you what to do for care on evenings, weekends and holidays?
Yes
No
In the last twelve months, if you needed care , were you able to get help from this office over the weekends, evenings or holidays?
Never
Sometimes
Usually
Always
Did not need
Did you get answers to medical questions on the same day you phoned?
Yes
No
Did you see the provider within 15 minutes of your appointment time?
Yes
No
Have you participated in a Telehealth visit with us?
Yes
No
Please tell us about your experience:
Did the provider explain things in a way that was easy to understand?
Yes
No
Have you been referred to a specialist in the last 12 months?
Yes
No
Did your provider seem to have up to date information about your visit with the specialist?
Yes
No
Did the provider respect what you had to say?
Yes
No
In the last 12 months did your provider talk to you about health goals?
Yes
No
Did your provider's office follow-up to give you results of a blood test, x-ray, or other test?
Yes
No
In the last 12 months did anyone ask you if there were things that make it hard to take care of yourself?
Yes
No
Did the provider talk to you about the reasons to take medication?
Yes
No
In the last 12 months, did anyone talk about a personal problem, family problem, alcohol or drug use or a mental or emotional illness?
Yes
No
In the last 12 months, has anyone talked to you about worry and stress in your life?
Yes
No
What is one thing you wish your provider would do differently?
Additional comments
If you were to refer us to someone else, what would you say to them?
