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Patient and Family Assessment of Activation and Satisfaction

Thank you for agreeing to provide your feedback about health information and communication with your primary health care provider, the person who delivers most of your care, for example your doctor, physician’s assistant or nurse practitioner. We are asking you to take only a few minutes to answer 15 questions. You may have completed this survey before, yet we would like your feedback again. Your individual responses will be kept confidential and not shared. Our staff will review all responses to help us understand where to make improvements.








For each question below, do you always, most of the time, sometimes or never do the following? Please answer these questions as truthfully and accurately as possible.
In thinking about your relationship with your primary health care provider, tell us if the following statements always, most of the time, sometimes or never happen.