1. How satisfied are you with the effect of your {treatment/care}?
□ Very satisfied	0
□ Satisfied	1
□ Neither satisfied nor dissatisfied	2
□ Dissatisfied	3
□ Very dissatisfied	4
2. How satisfied are you with the explanations the {doctor/other health professional} has given you about the results of your {treatment/care}?
□ Very dissatisfied	0
□ Dissatisfied	1
□ Neither satisfied nor dissatisfied	2
□ Satisfied	3
□ Very satisfied	4
3. The {doctor/other health professional} was very careful to check everything when examining you.
□ Strongly agree	0
□ Agree	1
□ Not sure	2
□ Disagree	3
□ Strongly disagree	4
4. How satisfied were you with the choices you had in decisions affecting your health care?
□ Very satisfied	4
□ Satisfied	3
□ Neither satisfied nor dissatisfied	2
□ Dissatisfied	1
□ Very disssatisfied	0
□ Very dissatisfied	0
□ Dissatisfied	1
□ Neither satisfied nor dissatisfied	2
□ Satisfied	3
□ Very satisfied	4
5. How much of the time did you feel respected by the {doctor/other health professional}?
□ All of the time	0
□ Most of the time	1
□ About half of the time	2
□ Some of the time	3
□ None of the time	4
6. The time you had with the {doctor/other health professional} was too short.
□ Strongly agree	0
□ Agree	1
□ Not sure	2
□ Disagree	3
□ Strongly disagree	4
7. Are you satisfied with the care you received in the {hospital/clinic}?
□ Very satisfied	0
□ Satisfied	1
□ Neither satisfied nor dissatisfied	2
□ Dissatisfied	3
□ Very dissatisfied	4