Patient Survey

Question Title

1. How long have you been a patient at The Ripa Center? (Required.)

1 year or less

2-4 years

5-7 years

8-10 years

Question Title

2. How would you rate the customer service provided by the staff? (Required.)

Excellent

Good

Fair

Poor

If you answered fair or poor, please explain:

Question Title

3. How would you rate your experience when calling The Ripa Center? (Required.)

Excellent

Good

Fair

Poor

If you answered fair or poor, please explain:

Question Title

4. How often are you able to schedule an appointment within your preferred time frame? (Required.)

Always

Often

Sometimes

Not often

If you answered sometimes or never, please explain:

Question Title

5. Which provider(s) do you typically see at The Ripa Center? (Required.)

Isadore Ances

Evren Burakgazi-Dalkilic

Consuelo Cagande

Divya Chillapalli

Barbara Evangelisti

Cynthia Griech-McCleery

Barbara Harry

Kathleen Heintz

Guy Hewlett

Donna Hogue

Ruksana Iftekhar

Tara Lautenslager

Rosemarie Leuzzi

Martha Matthews

Catharine Mayer

Farah Morgan

Ly Ngo

Robin Perry

Beth Ann Quattrocchi

Saadia Rehman

Dina Goldstein Silverman

Yon Sook Kim

Question Title

6. How would you rate the medical care you receive as a patient at The Ripa Center? (Required.)

Excellent

Good

Fair

Poor

If you answered fair or poor, please explain:

Question Title

7. Have you ever attended a class at The Ripa Center? (Required.)

Yes

If yes, which class did you attend and did you find it to be helpful?
If no, please explain:

Question Title

8. Please rate the following program options from 1-6, with 1 being of most interest to you. (Required.)

Holistic Medicine (acupuncture, aromatherapy, biofeedback, homeopathy, etc)

Menopause Management

Counseling Services (stress, anxiety, relationships, depression, etc)

Osteoporosis

Facial Rejuvenation (non-surgical and surgical)

Weight Management

Question Title

9. How likely are you to refer a family member or friend to The Ripa Center? (Required.)

Very likely

Likely

Somewhat likely

Not likely

If you answered somewhat likely or not likely, please explain:

Question Title

10. Do you have any additional comments?

Question Title

11. If you would like to be entered to win a $100 Visa gift card as a thank you for participating in this survey, please provide your name and contact information.

Name

Phone #

Email Address

Question Title

* 1. How long have you been a patient at The Ripa Center? (Required.)

Question Title

* 2. How would you rate the customer service provided by the staff? (Required.)

Question Title

* 3. How would you rate your experience when calling The Ripa Center? (Required.)

Question Title

* 4. How often are you able to schedule an appointment within your preferred time frame? (Required.)

Question Title

* 5. Which provider(s) do you typically see at The Ripa Center? (Required.)

Question Title

* 6. How would you rate the medical care you receive as a patient at The Ripa Center? (Required.)

Question Title

* 7. Have you ever attended a class at The Ripa Center? (Required.)

Question Title

* 8. Please rate the following program options from 1-6, with 1 being of most interest to you. (Required.)

Question Title

* 9. How likely are you to refer a family member or friend to The Ripa Center? (Required.)

Question Title

* 10. Do you have any additional comments?

Question Title

* 11. If you would like to be entered to win a $100 Visa gift card as a thank you for participating in this survey, please provide your name and contact information.

1. How long have you been a patient at The Ripa Center? (Required.)

2. How would you rate the customer service provided by the staff? (Required.)

3. How would you rate your experience when calling The Ripa Center? (Required.)

4. How often are you able to schedule an appointment within your preferred time frame? (Required.)

5. Which provider(s) do you typically see at The Ripa Center? (Required.)

6. How would you rate the medical care you receive as a patient at The Ripa Center? (Required.)

7. Have you ever attended a class at The Ripa Center? (Required.)

8. Please rate the following program options from 1-6, with 1 being of most interest to you. (Required.)

9. How likely are you to refer a family member or friend to The Ripa Center? (Required.)

10. Do you have any additional comments?

11. If you would like to be entered to win a $100 Visa gift card as a thank you for participating in this survey, please provide your name and contact information.