1. Patient Satisfaction Survey "Gynecological Services"

When you complete this survey, you will help our staff see themselves and the healthcare they provide through your eyes. We nee your criticism and suggetsions as well as your praise. Thank you for your honest repsonses.

* 1. Was this the first time you came to WBWC?

* 2. How did you hear of WBWC?

* 3. What was your primary reason for choosing WBWC?

* 4. Did you come for health care related to?

* 5. What is your age?

* 6. Rate your impression of the following using the rate system below:

  Excellent Good Adequate Needs Improvement N/A
Availability of Appointments
Telephone Answering
Facility Cleanliness
Supportive Environment
Follow/ Up care telephone calls or repeat visit
Opportunity to practice in Decision Making
Sufficient Explanations & Teaching

* 7. Please rate our competency, attitudes, and sensitivity to your needs (comments welcome)

  Excellent Good Adequate Needs Improvement N/A
Providers (FNP, CNMs)
Nurses (RNs)
Laboratory
Administration/Clerical

* 8. What did you specifically like that happened during your visit to WBWC?

* 9. How likely is it that you would recommend WBWC to your friends?

  1) Not Likely At All 2) 3) 4) 5) 6) 7) 8) 9) 10) Extremely Likely
On a 10 pt. Scale

* 10. What suggestions do you have to improve our gynecological services? Also, please leave final thoughts or comments in the box below:

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