Patient Survey

At WomanCare we strive to be the very best in patient care. In order to provide that care we turn to our patients for advice. Please take a moment to complete the patient survey below. We thank you in advance for your time and participation. The information below is confidential, and will only be used to improve our service.

1. Was this your first visit to our offices or have you been here before?

2. If you answered “First Visit” how did you hear about us?

3. What was the purpose of your visit?

4. What location did you visit?

5. Who was your practitioner?

On a scale of 1 to 5, with 5 being great how would you rate your experience on your last visit? If a particular line does not apply to your visit please skip it.

6. Ease of setting your appointment.

7. Greeting by our receptionist when you arrived.

8. Cleanliness/neatness of the waiting room.

9. Cleanliness/ neatness of the exam room.

10. Length of time you had to wait before you were called for your appointment.

11. Friendliness of our office staff.

12. Friendliness of the Medical Professional.

13. Quality of the service performed.

14. Degree to which your concerns were addressed.

15. The ease of checking out or paying after the appointment.

16. In your own words let us know any issues or concerns you may have about our services or office practices or procedures.

17. How likely is it that you would refer our practice to your family members, co-workers and friends?

If you would like to provide us with your contact information please use the boxes below:

18. Name

19. Phone Number

20. Email