EXIT THIS SURVEY 2018 Essex County OB/GYN Patient Survey Please rate your experience with the following aspects of your visit: Question Title * 1. Your waiting time in our reception area: Poor - More than 30 minutes Unsatisfactory - 20 to 30 minutes Acceptable - 10 to 20 minutes Very Good - Less than 10 minutes Poor - More than 30 minutes Unsatisfactory - 20 to 30 minutes Acceptable - 10 to 20 minutes Very Good - Less than 10 minutes OK Question Title * 2. Your waiting time in an exam room before your provider saw you: Poor - More than 15 minutes Unsatisfactory - 10 to 15 minutes Acceptable - 5 to 10 minutes Very Good - Less than 5 minutes Poor - More than 15 minutes Unsatisfactory - 10 to 15 minutes Acceptable - 5 to 10 minutes Very Good - Less than 5 minutes OK Question Title * 3. Ease of scheduling your appointment: Poor Needs Improvement Acceptable Very Good Poor Needs Improvement Acceptable Very Good If you gave 1 or 2 stars, please tell us what happened: OK Question Title * 4. The courtesy of the person who took your call: Unacceptable Needed Improvement Satisfactory Excellent Unacceptable Needed Improvement Satisfactory Excellent If you gave 1 or 2 stars, please tell us what happened: OK Question Title * 5. The courtesy of the Call Nurse (if you spoke with one): Unacceptable Needed Improvement Satisfactory Excellent Unacceptable Needed Improvement Satisfactory Excellent If you gave 1 or 2 stars, please tell us what happened: OK Question Title * 6. The friendliness and courtesy of the receptionist: Unacceptable Needed improvement Satisfactory Excellent Unacceptable Needed improvement Satisfactory Excellent If you gave 1 or 2 stars, please tell us what happened: OK Question Title * 7. Being kept informed if your appointment time was delayed: Unacceptable Unsatisfactory Acceptable Very Good Unacceptable Unsatisfactory Acceptable Very Good If you gave 1 or 2 stars, please tell us what happened: OK Question Title * 8. The caring concern of our nursing staff: Unacceptable Needed improvement Satisfactory Excellent Unacceptable Needed improvement Satisfactory Excellent If you gave 1 or 2 stars, please tell us what happened: OK Question Title * 9. The professionalism of our Ultrasound technicians (if you saw one): Unacceptable Needed improvement Satisfactory Excellent Unacceptable Needed improvement Satisfactory Excellent If you gave 1 or 2 stars, please tell us what happened: OK Question Title * 10. The courtesy and warmth of your care provider: Unacceptable Needed improvement Satisfactory Excellent Unacceptable Needed improvement Satisfactory Excellent If you gave 1 or 2 stars, please tell us what happened: OK Question Title * 11. Your provider's willingness to listen carefully to you and answer your questions: Unacceptable Needed improvement Satisfactory Excellent Unacceptable Needed improvement Satisfactory Excellent OK Question Title * 12. Your confidence in your care provider: Unacceptable Needed improvement Satisfactory Excellent Unacceptable Needed improvement Satisfactory Excellent If you gave 1 or 2 stars, please tell us what happened: OK Question Title * 13. The quality of the care you received from your provider: Unacceptable Needed improvement Satisfactory Excellent Unacceptable Needed improvement Satisfactory Excellent If you gave 1 or 2 stars, please tell us what happened: OK Question Title * 14. Would you recommend your care provider to others? Yes No If "No", please tell us why: OK Question Title * 15. Your overall satisfaction with our practice: Completely dissastisfied Somewhat dissatisfied Satisfied Completely satisfied Completely dissastisfied Somewhat dissatisfied Satisfied Completely satisfied Additional comments: OK Question Title * 16. We are considering expanding our office hours, in order to provider more convenient appointment times for our patients. Please check off the days/times that you would prefer. Monday Tuesday Wednesday Thursday Friday Saturday 7 am - 9 am 7 am - 9 am Monday 7 am - 9 am Tuesday 7 am - 9 am Wednesday 7 am - 9 am Thursday 7 am - 9 am Friday 7 am - 9 am Saturday 9 am - 12 pm 9 am - 12 pm Monday 9 am - 12 pm Tuesday 9 am - 12 pm Wednesday 9 am - 12 pm Thursday 9 am - 12 pm Friday 9 am - 12 pm Saturday 12 pm - 1 pm 12 pm - 1 pm Monday 12 pm - 1 pm Tuesday 12 pm - 1 pm Wednesday 12 pm - 1 pm Thursday 12 pm - 1 pm Friday 12 pm - 1 pm Saturday 1 pm - 5 pm 1 pm - 5 pm Monday 1 pm - 5 pm Tuesday 1 pm - 5 pm Wednesday 1 pm - 5 pm Thursday 1 pm - 5 pm Friday 1 pm - 5 pm Saturday 5 pm - 8 pm 5 pm - 8 pm Monday 5 pm - 8 pm Tuesday 5 pm - 8 pm Wednesday 5 pm - 8 pm Thursday 5 pm - 8 pm Friday 5 pm - 8 pm Saturday Other (please specify) OK Question Title * 17. What can we do to improve your experience with our practice? Your appointment: Our staff: Our practice: OK NEXT