recent doctor visit...
pleased with the service you
received from your doctor*
or other health care provider?
Was your visit
as pleasant as possible?
Was the staff
helpful and friendly?
Was the doctor
able to see you in a reasonable
amount of time?
Did your doctor help you resolve
your health problem?
Did s/he explain your situation so
you could understand it?
Did you have trouble communicating
with your doctor*?
Did you have a long wait to see
Was your doctor unprepared for your
Did s/he use medical terms you
Was s/he condescending, brusk or
Were you misdiagnosed or was there
another error made in your
term doctor is used here to
represent professional medical and
health care providers.
Patients have a right to be treated
respectfully and with the best medical
practices available. Providing feedback to
our medical providers helps them understand
how well they have met, exceeded, or failed
to meet those rights. Sharp patients know
itís important to provide feedback to their
doctors about office visits, quality of
care, and ability to communicate with the
doctor and his/her staff.
Doctorís Report Card is a good tool for patients
patient fills it out, grades the doctor and
his/her staff, and sends it directly to the
One aspect of being a good patient is
being a good health care consumer.
it this way: if your mechanic or hairdresser
or plumber or any other service provider is
doing a good job, then you thank them and
pay them and return to them when you need
them again. But if one of them is doing a lousy job,
then youíll either ask them to do it
differently Ė or youíll find someone else
who can provide that service instead.
For some reason, most patients donít take
the same approach with their medical
providers. Many of us feel paralyzed at
the thought of providing feedback, when
providing feedback can be the very thing
that improves not just our relationships
with our providers, but our
outcomes as well.
Providing feedback to
your provider, in the spirit of fair
is empowering for both you and
card will help you provide feedback to your
provider's office and staff:
cleanliness, handling of business details
his/her ability to listen, diagnostic
ability, ability to partner
The Doctors Report Card
print the report card,
then fill it out and mail it,
-- or --
fill it out in your browser,
then print it and mail it.
When you link to the report card,
you'll be asked to share your
Use of the
report card is free.
Privacy Statement: Information you
supply on this form will not be transferred
electronically; therefore we have no way of
retaining any information you input. All
your information will remain private and
secure since it cannot be collected.