Fort Collins Family Practice Medicine & Pediatric Care

Physician / Provider*

Courtesy of the person who scheduled your appointment*

Number of days you waited between your call and your appointment*

Getting an appointment time convenient for you*

Got to see your preferred doctor*

The courtesy of the receptionist*

The comfort and condition of the waiting area*

The amount of time you waited in the reception area before going to an exam room*

The courtesy of the nurse who prepared you for your visit*

The care provided by our nursing staff*

The amount of time you waited in the exam room for the physician / provider to arrive*

The respect and concern shown by your physician / provider*

How well your physician/provider listened when you explained your medical needs and concerns*

How well your physician/provider explained your care and treatment*

How well your physician/provider explained your medications (if any)*

Instructions your physician/provider gave you about follow-up care*

The thoroughness and completeness of your exam and medical treatment*

The amount of time your physician/provider spent with you*

How well your physician/provider involved you in decisions about your care*

The privacy of the environment including the protection of your confidential information*

Explanations about costs and paying for your care*

Help with your insurance questions*

Overall, how satisfied were you with the quality of care and services you received from our medical practice?*

Would you recommend our practice to your friends and family should they need medical care?*

How many times have you visited our practice in the past 12 months?*

What is your age?*

Gender*

How could we have improved your visit to our medical practice?

Name

This field is for validation purposes and should be left unchanged.

Rocky Mountain