FAYETTEVILLE WOMAN'S CARE PATIENT SATISFACTION SURVEY

* 1. Our records show that you got care from Fayetteville Woman's Care. Is that right?

* 2. Who did you see at your most recent visit?

* 3. How long have you been going to Fayetteville Woman's Care?

* 4. In the last 12 months, did you phone Fayetteville Woman's Care’s office to get an appointment for an illness, injury, or condition that needed care right away?

* 5. In the last 12 months, when you phoned Fayetteville Woman's Care’s office to get an appointment for care you needed right away, how often did you get an appointment as soon as you needed?

* 6. In the last 12 months, when you made an appointment for a check-up or routine care with Fayetteville Woman's Care, how often did you get an appointment as soon as you needed?

* 7. In the last 12 months, did you phone Fayetteville Woman's Care’s office with a medical question during regular office hours?

* 8. In the last 12 months, when you phoned Fayetteville Woman's Care’s office during regular office hours, how often did you get an answer to your medical question that same day?

* 9. In the last 12 months, when you contacted Fayetteville Woman's Care’s office with a medical question during regular office hours, did you interact with the Triage Nurse?

* 11. In the last 12 months, have you phoned Fayetteville Woman's Care’s office with a medical question after regular office hours?

* 12. In the last 12 months, when you phoned Fayetteville Woman's Care’s office after regular office hours, how often did you get an answer to your medical question as soon as you needed?

* 13. How long has it been since your most recent visit with Fayetteville Woman's Care?

* 14. During your most recent visit, did your healthcare provider explain things in a way that was easy to understand?

* 15. During your most recent visit, did your healthcare provider listen carefully to you?

* 16. During your most recent visit, did your healthcare provider seem to know the important information about your medical history?

* 17. During your most recent visit, did your healthcare provider show respect for what you had to say?

* 18. During your most recent visit, did your healthcare provider spend enough time with you?

* 19. During your most recent visit, did your healthcare provider order a blood test, x-ray, or other test for you?

* 20. Did someone from your healthcare provider’s office follow up to give you any abnormal results?

* 21. Using any number from 0 to 10, where 0 is the worst provider possible and 10 is the best experience possible, what number would you use to rate Fayetteville Woman's Care's coordination of any referrals you required?

  10 Best experience possible 9 8 7 6 5 4 3 2 1 0 Worst experience possible N/A
.

* 22. Using any number from 0 to 10, where 0 is the worst provider possible and 10 is the best provider possible, what number would you use to rate your healthcare provider?

  10 Best provider possible 9 8 7 6 5 4 3 2 1 0 Worst provider possible
.

* 23. Have you used the Patient Portal to send a message to the office or clinical staff?

* 24. Have you used the Patient Portal to review your medical information or lab results?

* 25. Have you used the Patient Portal to request a medication or medication refill?

* 26. Using any number from 0 to 10, where 0 is the worst provider possible and 10 is the best provider possible, how do you rate the Patient Portal for ease of use?

  10 Very Easy 9 8 7 6 5 4 3 2 1 0 Very Difficult
.

* 27. Would you recommend Fayetteville Woman's Care’s office to your family and friends?

* 28. During your most recent visit, did clerks and receptionists at Fayetteville Woman's Care’s office treat you with courtesy and respect?

* 29. What is your age?

* 30. What is the highest grade or level of school that you have completed?

* 31. Are you of Hispanic or Latino origin or descent?

* 32. What is your race? Mark one or more.

* 33. Do you have any other comments, questions, or concerns?

* 34. If you wish to be contacted, please provide your name and contact number.

T