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No. | Items | SA | A | NAD | D | SD |
5 | 4 | 3 | 2 | 1 |
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1 | Your doctor greeted you in a way that made you feel comfortable | | | | | |
2 | Discussed your reason(s) for coming today | | | | | |
3 | Encouraged you to express your thoughts concerning your health problems | | | | | |
4 | Listened carefully to what you had to say | | | | | |
5 | Understood what you had to say | | | | | |
6 | If a physical examination was required for your health concerns, the doctor fully explained what was done and why | | | | | |
7 | Explained the lab tests needed (e.g., blood, X-rays, ultrasound, etc.) | | | | | |
8 | Discussed treatment options with you | | | | | |
9 | Gave you as much information as you wanted | | | | | |
10 | Checked to see if the treatment plan(s) was acceptable to you | | | | | |
11 | Explained medications, if any, including possible side effects | | | | | |
12 | Encouraged you to ask questions | | | | | |
13 | Responded to your questions and concerns | | | | | |
14 | Showed concern about you as a person | | | | | |
15 | Involved you in decisions about your health as much as you wanted | | | | | |
16 | Discussed next steps including any follow-up plans | | | | | |
17 | Checked to be sure you understood everything | | | | | |
18 | Spent the right amount of time with you | | | | | |
19 | Overall, you were satisfied with your visit to the doctor today | | | | | |
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