Patient Satisfaction Survey for Arizona Wellness Center for Women

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1. PLEASE RATE THE FOLLOWING:
Your Appointment

	Excellent	Very Good	Good	Fair	Poor	N/A
Appointment availability within a reasonable amount of time.	*PLEASE RATE THE FOLLOWING: Your Appointment Appointment availability within a reasonable amount of time. Excellent	Appointment availability within a reasonable amount of time. Very Good	Appointment availability within a reasonable amount of time. Good	Appointment availability within a reasonable amount of time. Fair	Appointment availability within a reasonable amount of time. Poor	Appointment availability within a reasonable amount of time. N/A
The efficiency of the check-in process.	The efficiency of the check-in process. Excellent	The efficiency of the check-in process. Very Good	The efficiency of the check-in process. Good	The efficiency of the check-in process. Fair	The efficiency of the check-in process. Poor	The efficiency of the check-in process. N/A
Waiting time in the reception area.	Waiting time in the reception area. Excellent	Waiting time in the reception area. Very Good	Waiting time in the reception area. Good	Waiting time in the reception area. Fair	Waiting time in the reception area. Poor	Waiting time in the reception area. N/A
Waiting time in the exam room.	Waiting time in the exam room. Excellent	Waiting time in the exam room. Very Good	Waiting time in the exam room. Good	Waiting time in the exam room. Fair	Waiting time in the exam room. Poor	Waiting time in the exam room. N/A
Keeping you informed if your appointment was delayed.	Keeping you informed if your appointment was delayed. Excellent	Keeping you informed if your appointment was delayed. Very Good	Keeping you informed if your appointment was delayed. Good	Keeping you informed if your appointment was delayed. Fair	Keeping you informed if your appointment was delayed. Poor	Keeping you informed if your appointment was delayed. N/A

2. Our Staff

	Excellent	Very Good	Good	Fair	Poor	N/A
The courtesy of the person who took your call.	*Our Staff The courtesy of the person who took your call. Excellent	The courtesy of the person who took your call. Very Good	The courtesy of the person who took your call. Good	The courtesy of the person who took your call. Fair	The courtesy of the person who took your call. Poor	The courtesy of the person who took your call. N/A
The friendliness and courtesy of the receptionist.	The friendliness and courtesy of the receptionist. Excellent	The friendliness and courtesy of the receptionist. Very Good	The friendliness and courtesy of the receptionist. Good	The friendliness and courtesy of the receptionist. Fair	The friendliness and courtesy of the receptionist. Poor	The friendliness and courtesy of the receptionist. N/A
The caring concern of our medical assistants.	The caring concern of our medical assistants. Excellent	The caring concern of our medical assistants. Very Good	The caring concern of our medical assistants. Good	The caring concern of our medical assistants. Fair	The caring concern of our medical assistants. Poor	The caring concern of our medical assistants. N/A
The helpfulness of the people in our business office.	The helpfulness of the people in our business office. Excellent	The helpfulness of the people in our business office. Very Good	The helpfulness of the people in our business office. Good	The helpfulness of the people in our business office. Fair	The helpfulness of the people in our business office. Poor	The helpfulness of the people in our business office. N/A
The overall appearance of our staff.	The overall appearance of our staff. Excellent	The overall appearance of our staff. Very Good	The overall appearance of our staff. Good	The overall appearance of our staff. Fair	The overall appearance of our staff. Poor	The overall appearance of our staff. N/A
Was our surgery scheduler helpful and informative?	Was our surgery scheduler helpful and informative? Excellent	Was our surgery scheduler helpful and informative? Very Good	Was our surgery scheduler helpful and informative? Good	Was our surgery scheduler helpful and informative? Fair	Was our surgery scheduler helpful and informative? Poor	Was our surgery scheduler helpful and informative? N/A
The staff was sensitive to my privacy?	The staff was sensitive to my privacy? Excellent	The staff was sensitive to my privacy? Very Good	The staff was sensitive to my privacy? Good	The staff was sensitive to my privacy? Fair	The staff was sensitive to my privacy? Poor	The staff was sensitive to my privacy? N/A

3. Our communication with you

	Excellent	Very Good	Good	Fair	Poor	N/A
Was your phone call answered promptly.	*Our communication with you Was your phone call answered promptly. Excellent	Was your phone call answered promptly. Very Good	Was your phone call answered promptly. Good	Was your phone call answered promptly. Fair	Was your phone call answered promptly. Poor	Was your phone call answered promptly. N/A
Availability of medical information/advise by telephone.	Availability of medical information/advise by telephone. Excellent	Availability of medical information/advise by telephone. Very Good	Availability of medical information/advise by telephone. Good	Availability of medical information/advise by telephone. Fair	Availability of medical information/advise by telephone. Poor	Availability of medical information/advise by telephone. N/A
Explanation of your procedure/treatment.	Explanation of your procedure/treatment. Excellent	Explanation of your procedure/treatment. Very Good	Explanation of your procedure/treatment. Good	Explanation of your procedure/treatment. Fair	Explanation of your procedure/treatment. Poor	Explanation of your procedure/treatment. N/A
Your tests results reported in a reasonable amount of time.	Your tests results reported in a reasonable amount of time. Excellent	Your tests results reported in a reasonable amount of time. Very Good	Your tests results reported in a reasonable amount of time. Good	Your tests results reported in a reasonable amount of time. Fair	Your tests results reported in a reasonable amount of time. Poor	Your tests results reported in a reasonable amount of time. N/A
The staff returning your calls in a timely manner.	The staff returning your calls in a timely manner. Excellent	The staff returning your calls in a timely manner. Very Good	The staff returning your calls in a timely manner. Good	The staff returning your calls in a timely manner. Fair	The staff returning your calls in a timely manner. Poor	The staff returning your calls in a timely manner. N/A

4. Your visit with our providers

	Excellent	Very Good	Good	Fair	Poor	N/A
The provider (physician or physician assistant) listening to you.	*Your visit with our providers The provider (physician or physician assistant) listening to you. Excellent	The provider (physician or physician assistant) listening to you. Very Good	The provider (physician or physician assistant) listening to you. Good	The provider (physician or physician assistant) listening to you. Fair	The provider (physician or physician assistant) listening to you. Poor	The provider (physician or physician assistant) listening to you. N/A
The provider taking time to answer your questions.	The provider taking time to answer your questions. Excellent	The provider taking time to answer your questions. Very Good	The provider taking time to answer your questions. Good	The provider taking time to answer your questions. Fair	The provider taking time to answer your questions. Poor	The provider taking time to answer your questions. N/A
Amount of time the provider spent with you.	Amount of time the provider spent with you. Excellent	Amount of time the provider spent with you. Very Good	Amount of time the provider spent with you. Good	Amount of time the provider spent with you. Fair	Amount of time the provider spent with you. Poor	Amount of time the provider spent with you. N/A
The provider adequately explaining treatment options.	The provider adequately explaining treatment options. Excellent	The provider adequately explaining treatment options. Very Good	The provider adequately explaining treatment options. Good	The provider adequately explaining treatment options. Fair	The provider adequately explaining treatment options. Poor	The provider adequately explaining treatment options. N/A
The providers instructions regarding medication/follow up care.	The providers instructions regarding medication/follow up care. Excellent	The providers instructions regarding medication/follow up care. Very Good	The providers instructions regarding medication/follow up care. Good	The providers instructions regarding medication/follow up care. Fair	The providers instructions regarding medication/follow up care. Poor	The providers instructions regarding medication/follow up care. N/A
The thoroughness of the examination.	The thoroughness of the examination. Excellent	The thoroughness of the examination. Very Good	The thoroughness of the examination. Good	The thoroughness of the examination. Fair	The thoroughness of the examination. Poor	The thoroughness of the examination. N/A
Was the provider friendly and courteous?	Was the provider friendly and courteous? Excellent	Was the provider friendly and courteous? Very Good	Was the provider friendly and courteous? Good	Was the provider friendly and courteous? Fair	Was the provider friendly and courteous? Poor	Was the provider friendly and courteous? N/A

5. Your overall satisfaction with:

	Excellent	Very Good	Good	Fair	Poor	N/A
The appearance and neatness of the office.	*Your overall satisfaction with: The appearance and neatness of the office. Excellent	The appearance and neatness of the office. Very Good	The appearance and neatness of the office. Good	The appearance and neatness of the office. Fair	The appearance and neatness of the office. Poor	The appearance and neatness of the office. N/A
Our practice.	Our practice. Excellent	Our practice. Very Good	Our practice. Good	Our practice. Fair	Our practice. Poor	Our practice. N/A
The quality of your medical care.	The quality of your medical care. Excellent	The quality of your medical care. Very Good	The quality of your medical care. Good	The quality of your medical care. Fair	The quality of your medical care. Poor	The quality of your medical care. N/A

6. If there is any way we can improve our service to you, please let us know:

If there is any way we can improve our service to you, please let us know: