Member Survey Form

Scheduling

1.The purpose of my wellness visit was clearly explained during my scheduling call.(Required.)

2.I found it convenient to schedule a wellness visit.(Required.)

Fusion Advantage Clinician

3.The clinician identified themselves and explained the purpose of the wellness visit.(Required.)

4.The clinician took the time to answer my questions and concerns.(Required.)

5.The clinician showed a genuine interest in my health and well-being.(Required.)

Labs/Diagnostic Tests (not performed on all members)

6.I found it convenient to complete the labs and diagnostic tests during my wellness visit.(Required.)

7.I understood why the recommended labs and/or diagnostic tests were important for my health.(Required.)

Wellness Visit

8.The information shared during my wellness visit helped me better understand my health.(Required.)

9.I will discuss my wellness visit and any completed test results with my doctor.(Required.)

Overall Experience

10.What did you find most helpful in your wellness visit?(Required.)

Changes to my lifestyle.

Things to talk about with PCP.

A new condition.

Nothing

11.How likely are you to recommend a wellness visit to a friend or family member?(Required.)

0 = Least Likely

10 = Most Likely

12.Is there anything else you would like to tell us about your experience?

Note: Please do not enter any sensitive, confidential health, or personally identifiable information in this field.