WHCMA Patient Satisfaction Survey

Women's Health of Central MA - Patient Satisfaction Survey

The doctors and staff at Women’s Health of Central MA would like to know how you feel about the services we provide so we can make sure we are meeting your needs and providing every patient with the highest quality care. Your responses are directly responsible for improving these services. All responses will be kept confidential and anonymous. Thank you for your time.

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* 1. In what year were you born? (enter 4-digit birth year; for example, 1976)

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* 2. Are you White, Black or African-American, American Indian or Alaskan Native, Asian, Native Hawaiian or other Pacific islander, or some other race?

White

Black or African-American

American Indian or Alaskan Native

Asian

Native Hawaiian or other Pacific Islander

From multiple races

Unknown or prefer not to answer

Some other race (please specify)

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* 3. What is the highest level of school that you have completed?

Primary school

Some high school, but no diploma

High school diploma (or GED)

Some college, but no degree

2-year college degree

4-year college degree

Graduate-level degree

None of the above

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* 4. Please answer the following survey questions based on your MOST RECENT visit to WHCMA.
With which provider did you have an appointment?

Amy Chang, MD

Christopher Conlan, MD

Peter Davidow, MD

Dina Deldon-Saltin, DO

Jaimee DeMone, MD

John Farricy, MD

Abraham Fischer, MD

Tiffany Forti, MD, MPH

Cindy Joslyn, CNM

Meredith Kern, MD

Susan Kraft, MD

June O'Connor, MD

Kerri Osterhaus-Houle, MD

Stanley Surette, MD

Leah Wilson, MD

Other

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* 5. Do you consider this physician your regular source of Ob/Gyn care?

Yes

No, I usually go to another provider at WHCMA for my care

No, I usually go to another provider at a different practice for my care

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* 6. At which office location was this appointment?

Marlborough

Webster Lake

328 Shrewsbury Street, Worcester

123 Summer Street (St. Vincent Hospital), Worcester

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* 7. How long ago was this appointment?

Less than 1 week ago

1 week to 1 month ago

2-6 months ago

More than 6 months ago

Question Title

* 1. In what year were you born? (enter 4-digit birth year; for example, 1976)

Question Title

* 2. Are you White, Black or African-American, American Indian or Alaskan Native, Asian, Native Hawaiian or other Pacific islander, or some other race?

Question Title

* 3. What is the highest level of school that you have completed?

Question Title

* 4. Please answer the following survey questions based on your MOST RECENT visit to WHCMA. With which provider did you have an appointment?

Question Title

* 5. Do you consider this physician your regular source of Ob/Gyn care?

Question Title

* 6. At which office location was this appointment?

Question Title

* 7. How long ago was this appointment?

* 4. Please answer the following survey questions based on your MOST RECENT visit to WHCMA.
With which provider did you have an appointment?