Overlake Reproductive Health Survey

1. Overlake Reproductive Health ~ Patient Satisfaction Survey

Thank you for being an ORH patient. We hope you can take the next 2-5 minutes to complete the following survey. Your feedback will help us improve the quality of our care and service. For taking the time to give us feedback, we have a small gift of appreciation. By completing this survey you will receive instructions for receiving your gift. Again, thank you very much for your comments. We reserve the right to use your responses, anonymously, in our promotional material.

1. How did you hear about ORH? More than one answer is allowed.

How did you hear about ORH? More than one answer is allowed. Friend

Physician

Web Search

Advertising

Advertising: Please provide the source

2. Please indicate your overall satisfaction with our clinical staff:

	Very Good	Good	Poor	Not Applicable (N/A)
Physicians	Please indicate your overall satisfaction with our clinical staff: Physicians Very Good	Physicians Good	Physicians Poor	Physicians Not Applicable (N/A)
Nurse Practitioners	Nurse Practitioners Very Good	Nurse Practitioners Good	Nurse Practitioners Poor	Nurse Practitioners Not Applicable (N/A)
Medical Assistants	Medical Assistants Very Good	Medical Assistants Good	Medical Assistants Poor	Medical Assistants Not Applicable (N/A)
Laboratory Personnel	Laboratory Personnel Very Good	Laboratory Personnel Good	Laboratory Personnel Poor	Laboratory Personnel Not Applicable (N/A)
Anesthesiologists	Anesthesiologists Very Good	Anesthesiologists Good	Anesthesiologists Poor	Anesthesiologists Not Applicable (N/A)

Please provide specific, individual feedback:

3. Please indicate your overall satisfaction with our business staff:

	Very Good	Good	Poor	Not Applicable (N/A)
Front Desk (Check-in)	Please indicate your overall satisfaction with our business staff: Front Desk (Check-in) Very Good	Front Desk (Check-in) Good	Front Desk (Check-in) Poor	Front Desk (Check-in) Not Applicable (N/A)
Front Desk (Check-out)	Front Desk (Check-out) Very Good	Front Desk (Check-out) Good	Front Desk (Check-out) Poor	Front Desk (Check-out) Not Applicable (N/A)
Finance Staff (Financial Discussion)	Finance Staff (Financial Discussion) Very Good	Finance Staff (Financial Discussion) Good	Finance Staff (Financial Discussion) Poor	Finance Staff (Financial Discussion) Not Applicable (N/A)
Administrative Staff (Problem solving)	Administrative Staff (Problem solving) Very Good	Administrative Staff (Problem solving) Good	Administrative Staff (Problem solving) Poor	Administrative Staff (Problem solving) Not Applicable (N/A)
Washington Medical Billing (Independent billing company)	Washington Medical Billing (Independent billing company) Very Good	Washington Medical Billing (Independent billing company) Good	Washington Medical Billing (Independent billing company) Poor	Washington Medical Billing (Independent billing company) Not Applicable (N/A)
Notary Services (Consent signing)	Notary Services (Consent signing) Very Good	Notary Services (Consent signing) Good	Notary Services (Consent signing) Poor	Notary Services (Consent signing) Not Applicable (N/A)

Please provide specific,individual feedback:

4. Please add any other comments or thoughts that would help us improve our customer service and clinical care. Please recognize any member of our staff who exceeded your expectations:

Please add any other comments or thoughts that would help us improve our customer service and clinical care. Please recognize any member of our staff who exceeded your expectations:

5. RESPONSE OPTIONAL: Please provide your name and phone number if you wish a member of our staff to follow-up with you. Thank you for taking the time to complete this survey.

For your complimentary Starbucks (Gift) Card, please say the word "FERTILITY" to a member of our Front Desk Staff. They will provide you with the card. One card per patient.

Thank you, again, for being our patient and taking the time to help us improve our care and service.

RESPONSE OPTIONAL: Please provide your name and phone number if you wish a member of our staff to follow-up with you. Thank you for taking the time to complete this survey. For your complimentary Starbucks (Gift) Card, please say the word "FERTILITY" to a member of our Front Desk Staff. They will provide you with the card. One card per patient. Thank you, again, for being our patient and taking the time to help us improve our care and service.

Overlake Reproductive HealthExit this survey

1. Overlake Reproductive Health ~ Patient Satisfaction Survey

1. How did you hear about ORH? More than one answer is allowed.

2. Please indicate your overall satisfaction with our clinical staff:

3. Please indicate your overall satisfaction with our business staff:

4. Please add any other comments or thoughts that would help us improve our customer service and clinical care. Please recognize any member of our staff who exceeded your expectations:

Overlake Reproductive Health
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