Strongly
Agree
Agree
Neutral
Disagree
Strongly
Disagree
1.) When you called our office, your call was handled promptly and courteously.
2.) Your appointments were made within a reasonable time frame.
3.) The receptionist acknowledged and greeted you when you arrived.
4.) The waiting area was clean and comfortable.
5.) The medical staff (your nurse) was friendly and courteous.
6.) You received adequate time with the provider.
7.) You felt comfortable making comments and asking questions of your provider.
8.) The details of your treatment were explained to you in words you understood.
9.) You would recommend our providers to a co-worker or family member.
10.) Our providers have a good "bed-side" manner. (courteous, respectful, etc.)
11.) The time you waited to be seen by a provider was reasonable.
12.) Parking is convenient
13.) Getting lab results was timely. (if applicable)
14.) You received appropriate information about medications (if any)
15.) Insurance and billing personnel have been helpful (if applicable)
16.) You were pleased with your overall experience with our office.
17) Why did you choose The Women's Healthcare Group for your care? (check as many as apply)
  Reputation for quality care  
  Location - close to home or office  
  Insurance required  
  Advertisement - (What Type? TV Radio Magazine Newspaper Billboard)
  Cost
  Previous visit
  Yellow pages
  Referral - physician or family member / friend
  Other
18.) What is the most important thing we can do to improve our services?
 
19). Was there a specific staff member who went "above and beyond" to assist you?
  Name of Staff Member:
20.) At my last visit, I saw:
  Physicians: Certified Nurse Midwives:
  Dennis R. Johnson, MD Felicia Rohrbaugh, MSN, CNM
  William M. Unwin, MD Deborah A. Brown, MSN, CNM
  Kathryn K. Hassinger, MD Carol L. Landry, MSN, CNM
  John J. Lawrence, MD Nurse Practitioner:
  Meg K. Figdore, MD Holly A. Shearer, MSN, CRNP
Janet L. Ashby, MSN, CRNP
21.) Date of my visit:
22.) Your Age: ( Under 18 18-25 26-45 46-55 56-70)
23.) Additional Comments:
 
   
   
   
   
 
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