Austin Bariatric Clinic Survey
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1. Default Section
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1
. How satisfied are you with your weight loss experience at Austin Bariatric Clinic? Please feel free to elaborate on your response.
How satisfied are you with your weight loss experience at Austin Bariatric Clinic? Please feel free to elaborate on your response.
1. Extremely satisfied
2. Mostly satisfied
3. Somewhat satisfied
4. Not very satisfied
5. Extremely unsatisfied
Other (please specify)
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2
. Which doctors or doctors have you seen.
Which doctors or doctors have you seen.
1. Dr. Amanda Dupont
2. Dr. Teresa Boehm
3. I have seen both doctors
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3
. Have you ever had an appointment with our Clinical Nurse Specialist Kelly Cipparone?
Have you ever had an appointment with our Clinical Nurse Specialist Kelly Cipparone?
yes
no
4
. Can you please rate your experience with our Clinical Nurse Specialist
Can you please rate your experience with our Clinical Nurse Specialist
1. Excellent, I would see her again.
2. Good, I would consider seeing her again.
3. Fair, I would rather see the doctor, but would see her if the doctor is unavailable.
4. Poor, I would not see her again.
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5
. Have you ever been to another medical weight loss clinic in Austin?
Have you ever been to another medical weight loss clinic in Austin?
1. Yes
2. No
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. If applicable, how would you rate your experience at Austin Bariatric Clinic in comparison to any other medical weight loss clinic in Austin you have been to.
If applicable, how would you rate your experience at Austin Bariatric Clinic in comparison to any other medical weight loss clinic in Austin you have been to.
1. I have had a better experience at Austin Bariatric Clinic.
2. I find them to be mostly similar experiences.
3. I have had a better experience at another medical weight loss clinic.
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7
. Do you use any of the high protein nutritional foods at our clinic? Please feel free to add any comments about the food products.
Do you use any of the high protein nutritional foods at our clinic? Please feel free to add any comments about the food products.
1. Yes, I use them on a regular basis.
2. Yes, I use them on occasion.
3. I almost never use any of the high protein foods available at the clinic.
4. No, I have never used any of the food available.
Other (please specify)
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8
. How would you rate our office staff? Please feel free to make additional comments.
How would you rate our office staff? Please feel free to make additional comments.
1. Very helpful and courteous. I always feel like a valued customer.
2. Mostly helpful and courteous, with some areas of customer service lacking.
3. Sometimes helpful and courteous, but needs significant improvement.
4. Mostly unhelpful or discourteous
Other (please specify)
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9
. How would you rate our office hours and availability? Please comment on how you feel we can better serve our patients.
How would you rate our office hours and availability? Please comment on how you feel we can better serve our patients.
1. Good hours and availability. I never have a problem scheduling an appointment.
2. Mostly good, but additional office hours would be helpful.
3. Very difficult to schedule an appointment.
Other (please specify)
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10
. How would you rate the appearance of the office and patient rooms. Comments are welcome.
How would you rate the appearance of the office and patient rooms. Comments are welcome.
1. Nice and professional appearance. Comfortable office space.
2. Decent appearance, with minor cosmetic changes suggested.
3. Needs significant improvement.
Other (please specify)
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