Positive Healthcare Experience

Marital Status:

Married with children

Single with children

Married without children

Single without children

Ethnic Background:

What is the highest level of school you have completed or the highest degree you have received?

Which category below includes your age?

I prepare questions for my medical provider prior to my appointment.

Always

Sometimes

Never

My medical provider takes sufficient time to answer all my questions.

Always

Sometimes

Never

I am comfortable discussing all issues relative to my healthcare with my medical provider.

Always

Sometimes

Never

I question my medical provider's instructions when I don't understand or can't comply.

Always

Sometimes

Never

I feel that my medical provider focuses on me and my needs during the appointment.

Always

Sometimes

Never

I leave the appointment knowing what I need to do as a follow-up.

Always

Sometimes

Never