Date of your Visit:

Let us know when you visited Metro Community Health

Name of Doctor

Metro Site

Person Completing Survey

If you picked Staff, please specify. If you picked Other, please specify

Reason for Today’s Visit?

If you picked other, please specify

Patient Gender

Patient Age

Patient Lives

If you picked other, please specify

1. Are you able to see your doctor when you need to?

2. Can you be seen on the same day that you call for an appointment?

3. Do you know that there is a phone number that you can call to receive medical advice from a doctor at Metro after regular office hours?

4. When you call your doctor with a medical question do you get an answer on that same day?

5. Do you find our health center and health services easy to access?

6. On most visits, are you able to see your doctor within 15 minutes of your appointment time (wait time includes time spent in the waiting room and exam room).

7. Does your doctor speak directly to you (the patient) about your health and medical conditions? (Rather than addressing the person who is with the patient during their visit)

8. Does your doctor explain things in a way that is easy to understand?

9. Does your doctor talk with you about the medications you are taking at each visit?

10. Does your doctor consider your (the patient) wishes and personal goals when creating a treatment plan?

11. Do you feel that your doctor knows the most current and effective treatments for your condition(s)?

12. Are medical staff friendly and helpful?

13. When blood tests, x-rays, or other tests are ordered, does Metro give you the results?

14. Medical specialists are doctors who specialize in an area of healthcare (like surgeons, heart doctors, allergy doctors, skin doctors). If you have received care from a specialist does your doctor at Metro seem to know about the care you received?

15. When you call to renew a medication is your prescription sent to your pharmacy or made available to you on that same day?

16. Does your doctor provide information on ways to improve your health?

17. Has your doctor asked if there are things that make it hard for you to take care of your health?

18. Have Metro staff recommended services in your community or offered their own workshops to help improve your health (for example, weight management groups, nutrition/meal support)?

19. Are recommendations you received (including community-service and supports) to improve your health helpful?

20. Do you face any financial barriers to receiving care at Metro

21. Would you recommend Metro to your friends and family?

22. Would you recommend your doctor at Metro to your friends and family?

Please leave your comments here:

Please complete the following questions if you have received Telehealth services with MCHC

Reason for Today’s Telehealth Visit?

If you picked other, please specify

1. Did you have trouble using Telehealth services at MCHC

2. Did you feel your Telehealth visit was as good as a traditional office visit?

3. Would you use Telehealth at MCHC again?

4. Would you recommend MCHC Telehealth services to your friends and family?

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