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1 = Strongly Disagree 2 = Disagree 3 = Agree 4 = Strongly Agree 5 = NA

---12345 Staff was courteous and helpful.

---12345 Staff provided complete, accurate information.

---12345 The level of service provided met your expectations.

---12345 I would recommend Access Health Care Services Inc. to others.

---12345 Access Health Care Services Inc. clinic location and hours of operation are convenient.

---12345 Level of communication between you and your nurse met your expectations.

---12345 Contacting a nurse after hours was not an issue.

---12345 Access Health Care Services Inc.’s website was helpful.

---12345 Overall satisfaction level with your Access Health Care Services Inc. experience.

Please indicate the name(s) of any staff person you would like to commend:

Comments

If you feel we fell short in meeting your expectations, please describe the situation, including the name of the staff person involved and the date the incident occurred:

Are you pleased with your services? What did you think of your services, in terms of quality and professionalism?

Can you offer us any comments on our web site? Is there anything you found confusing, or felt could be improved?