Skip to main content
Medical Sleep Solutions
Home
Announcements
About Sleep Disorders
Types of Sleep Disorders
Sleep Apnea
Insomnia
Narcolepsy
Restless Leg Syndrome RLS
Special Sleep Issues
Telemedicine
For Patients
Patient Forms
Accepted Insurances
About
Dr. Edwin Charnock
Dr. Jack Gardner
Kim Mihelich
Chrystal Keys
Why choose Medical Sleep Solutions
Philips PAP Recall
Medical Sleep Solutions
Home
Announcements
About Sleep Disorders
Types of Sleep Disorders
Sleep Apnea
Insomnia
Narcolepsy
Restless Leg Syndrome RLS
Special Sleep Issues
Telemedicine
For Patients
Patient Forms
Accepted Insurances
About
Dr. Edwin Charnock
Dr. Jack Gardner
Kim Mihelich
Chrystal Keys
Why choose Medical Sleep Solutions
Philips PAP Recall
Patient Response
Dr. Gardner with Medical Sleep Solutions
Date of visit/evaluation
MM slash DD slash YYYY
Please select a performance rating for your doctor for each of the following questions:
Did this doctor explain things in a way that was easy to understand?
(Required)
Yes, definitely
Yes, somewhat
No
Did this doctor listen carefully to you?
(Required)
Yes, definitely
Yes, somewhat
No
Did you talk with this doctor about any health problems or concerns?
(Required)
Yes, definitely
Yes, somewhat
No
Did this doctor give you easy to understand instructions about taking care of those health problems or concerns?
(Required)
Yes, definitely
Yes, somewhat
No
Did this doctor seem to know the important information about your medical history?
(Required)
Yes, definitely
Yes, somewhat
No
Did this doctor show respect for what you had to say?
(Required)
Yes, definitely
Yes, somewhat
No
Did this doctor spend enough time with you?
(Required)
Yes, definitely
Yes, somewhat
No
Please fill out this form and submit for this doctor's confidential records.