| CARES QUESTIONNAIRE |
| How good was your physician at: |
Poor |
Fair |
Very Good |
Excellent |
Does Not Apply |
| 1. Making you feel at ease (introducing him/herself, explaining his/her position, being friendly and warm towards you, treating you with respect; not cold or abrupt) |
| 2. Letting you tell your “story” (giving you time to fully describe your condition in your own words; not interrupting, rushing, or diverting you) |
| 3. Really listening (paying close attention to what you were saying, not looking at the notes or computer as you were talking) |
| 4. Being interested in you as a whole person (asking/knowing relevant details about your life, your situation; not treating you as “just a number”) |
| 5. Fully understanding your concerns (communicating that he/she had accurately understood your concerns and anxieties; not overlooking or dismissing anything) |
| 6. Showing care and compassion (seeming genuinely concerned, connecting with you on a human level; not being indifferent or “detached”) |
| 7. Being positive (having a positive approach and a positive attitude; being honest but not negative about your problems) |
| 8. Explaining things clearly (fully answering your questions; explaining clearly, giving you adequate information; not being vague) |
| 9. Helping you to take control (exploring with you what you can do to improve your health yourself; encouraging rather than “lecturing” you) |
| 10. Making a plan of action with you (discussing the options, involving you in decisions as much as you want to be involved; not ignoring your views) |
| Comments: If you would like to add further comments on this consultation, please do so here. |
