Sample Questions from the Religion and Spirituality in the Medical Encounter Study

	Strongly Agree	Agree	Neutral	Disagree	Strongly Disagree
My doctor should not play a role in my spiritual or religious life.	1	2	3	4	5
My doctor should be aware of my religious or spiritual beliefs.	1	2	3	4	5
My doctor should ask me about my religious or spiritual beliefs during a routine office visit.	1	2	3	4	5
If I am near death, my doctor should ask me about my religious or spiritual beliefs.	1	2	3	4	5
If I am hospitalized, but not near death, my doctor should ask me about my religious or spiritual beliefs.	1	2	3	4	5
My doctor should say a silent prayer for me during a routine office visit.	1	2	3	4	5
My doctor should pray with me during a routine office visit.	1	2	3	4	5
If I were in the hospital, my doctor should say a silent prayer for me.	1	2	3	4	5
If I were in the hospital, my doctor should pray with me.	1	2	3	4	5
If I am dying, my doctor should say a silent prayer for me.	1	2	3	4	5
If I am dying, my doctor should pray with me.	1	2	3	4	5
It is important to me that my doctor has strong spiritual beliefs.	1	2	3	4	5