CAHPS Survey PCMH | QuestionPro

* Our records show that you got care from the provider named below in the last 12 months.

Is this the provider you usually see if you need a check-up, want advice about a health problem, or get sick or hurt?

Yes

No

How long have you been going to this provider?

Less than 6 months

At least 6 months but less than 1 year

At least 1 year but less than 3 years

At least 3 years but less than 5 years

5 years or more

These questions ask about your own health care. Do not include care you got when you stayed overnight in a hospital. Do not include the times you went for dental care visits.

In the last 12 months, how many times did you visit this provider to get care for yourself?

In the last 12 months, did you phone this provider’s office to get an appointment for an illness, injury or condition that needed care right away?

Yes

2 No → If No, go to #8

In the last 12 months, when you phoned this provider’s office to get an appointment for care you needed right away, how often did you get an appointment as soon as you needed?

Never

Sometimes

Usually

Always

In the last 12 months, how many days did you usually have to wait for an appointment when you needed care right away?

In the last 12 months, did you make any appointments for a check-up or routine care with this provider?

Yes

No → If No, go to #10

In the last 12 months, when you made an appointment for a check-up or routine care with this provider, how often did you get an appointment as soon as you needed?

Never

Sometimes

Usually

Always

Did this provider’s office give you information about what to do if you needed care during evenings, weekends, or holidays?

Yes

No