Patient Experience Question Title * 1. The check-in staff was welcoming, friendly and helpful. Yes No If you answered No, please tell us more. Question Title * 2. If you used the Kiosk to check in please tell us what you thought about the process. Question Title * 3. How do you feel about the amount of time it took you to get an appointment? Excellent Good Fair Poor Question Title * 4. The length of time you spent waiting in the office Excellent Good Fair Poor Question Title * 5. The amount of time spent with the provider you saw Excellent Good Fair Poor Question Title * 6. The personal manner (courtesy, respect, sensitivity, friendliness) of the provider you saw Excellent Good Fair Poor Question Title * 7. The provider's sensitivity to your needs and/or concerns Excellent Good Fair Poor Question Title * 8. Your satisfaction with how well this office communicates with other providers involved in your care Excellent Good Fair Poor Question Title * 9. Your feeling about the overall quality of this visit Excellent Good Fair Poor Question Title * 10. If you could go anywhere to get healthcare, would you choose this practice or prefer to go somewhere else? Choose this practice Prefer to go elsewhere Question Title * 11. Would you recommend this practice to your friends, family and peers? Yes No If you chose No, please tell us why Question Title * 12. What is your age? Under 25 years 25-44 45-64 65+ years Question Title * 13. Who is your provider: Dr. Kevin Andrews Dr. Carla Burkley Dr. Cecilia Caldwell Dr. Erin Dawson-Chalat Dr. Jennifer Shinners Dr. Barbara Slager Dr. Tasha Worster Dr. Joshua Sinkin Patty Bryan, CRNP Ashley Pratt, WHNP Deanna Bennett, FNP Suzette Cyr, PMHNP Question Title * 14. How did you hear about Coastal Women's Healthcare? Family Member Friend Primary Care Physician Referral from another facility Website Social Media Television Long-Term Patient Other (please specify) Question Title * 15. Is Coastal Women's Healthcare your sole provider for medical care? Yes No Question Title * 16. Additional Comments Question Title * 17. Your Name (Optional) Done
