This free survey is powered by
QUESTIONPRO.COM
Create a Survey
Surveys
2012
October
C
CAHPS Survey PCMH
CAHPS Survey PCMH
0%
Exit Survey »
*
Our records show that you got care from the provider named below in the last 12 months.
-- Select --
Dr. Robert Nielsen
Dr. David Heeter
Dr. George Loose
Dr. David Engle
Dr. Erin Juliano
Dr. Melissa Stapinski
Dr. Julie Header
Kristen Mace PA-C
Leanne Kantner CRNP
NONE - If None, go to # 44
Is this the provider you usually see if you need a check-up, want advice about a health problem, or get sick or hurt?
Yes
No
How long have you been going to this provider?
Less than 6 months
At least 6 months but less than 1 year
At least 1 year but less than 3 years
At least 3 years but less than 5 years
5 years or more
These questions ask about your own health care. Do not include care you got when you stayed overnight in a hospital. Do not include the times you went for dental care visits.
In the last 12 months, how many times did you visit this provider to get care for yourself?
None
→ If None, go to question #44
1 time
2
3
4
5 to 9
10 or more times
In the last 12 months, did you phone this provider’s office to get an appointment for an illness, injury or condition that
needed care right away
?
Yes
2 No
→ If No, go to #8
In the last 12 months, when you phoned this provider’s office to get an appointment for
care you needed right away
, how often did you get an appointment as soon as you needed?
Never
Sometimes
Usually
Always
In the last 12 months, how many days did you usually have to wait for an appointment when you
needed care right away
?
Same day
1 day
2 to 3 days
4 to 7 days
More than 7 days
In the last 12 months, did you make any appointments for a
check-up or routine care
with this provider?
Yes
No → If No, go to #10
In the last 12 months, when you made an appointment for a
check-up or routine care
with this provider, how often did you get an appointment as soon as you needed?
Never
Sometimes
Usually
Always
Did this provider’s office give you information about what to do if you needed care during evenings, weekends, or holidays?
Yes
No
Loading...
close
Loading...
Close
staticapp1.questionpro.net