For Women, PA Patient Satisfaction Survey

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* 1. In the last 12 months, did you phone Dr. Elizabeth Motyka’s office to get an appointment for an urgent problem?

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* 2. In the last 12 months, when you phoned Dr. Elizabeth Motyka’s office to get an appointment for care you needed right away, how often did you get an appointment as soon as you needed?

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* 3. In the last 12 months, did you make any appointments for a check-up or routine care with Dr. Elizabeth Motyka?

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* 4. In the last 12 months, when you made an appointment for a check-up or routine care with Dr. Elizabeth Motyka, how often did you get an appointment as soon as you needed?

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* 5. In the last 12 months, did you contact Dr Elizabeth Motyka’s office with a medical question during regular office hours?

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* 6. In the last 12 months, when you contacted Dr. Elizabeth Motyka’s office during regular office hours, how often did you get an answer to your medical question that same day?

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* 7. In the last 12 months, did you phone Dr. Elizabeth Motyka’s office with a medical question after regular office hours?

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* 8. After-hour emergencies are covered via phone by the on-call doctor, who can be reached by calling the office. In the last 12 months, when you phoned Dr Elizabeth Motyka’s office after regular office hours, how often did you get an answer to your medical question as soon as you needed?

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* 9. Wait time includes time spent in the waiting room and exam room. In the last 12 months, how often did you see someone from your care team, front office staff or medical assistant, within 15 minutes of your appointment time?

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* 10. Wait time includes time spent in the waiting room and exam room. During your most recent visit, did you see someone from your care team, front office staff or medical assistant, within 15 minutes of your appointment time?

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* 11. Non-urgent questions related to follow-up of recent office visits, test results, prescriptions, and established care plans can be sent in via the patient portal. The portal is checked hourly throughout the day during office hours. The portal is not checked after hours or on holidays or weekends. If you have used the portal during normal office hours, did you find it a convenient way to communicate with the practice?

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* 12. Most insurance companies are now allowing electronic portal questions to be covered (some being subject to normal co-pays and deductibles.) Many portal questions can be completely resolved in less than 5 minutes over the portal. I do not charge a fee for these short portal messages. For complex questions, especially involving new problems that require more than 5 minutes, we will be offering the option of a portal charged visit, telehealth visit, or in-office visit. Which option would you prefer?

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* 13. In the past 12 months, have you scheduled a telehealth visit with Dr. Elizabeth Motyka?

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* 14. If you have had a telehealth visit with Dr. Elizabeth Motyka, were you satisfied with the experience?

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* 15. Would you schedule telehealth visits when appropriate even after the pandemic circumstances no longer require it?

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* 16. During your most recent visit, did Dr. Elizabeth Motyka explain things in a way that was easy to understand?

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* 17. During your most recent visit, did Dr. Elizabeth Motyka listen carefully to you?

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* 18. During your most recent visit, did Dr. Elizabeth Motyka spend enough time with you?

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* 19. During your most recent visit, did Dr. Elizabeth Motyka show respect for what you had to say?

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* 20. During your most recent visit, did Dr. Elizabeth Motyka order a blood test, x-ray, or other test for you?

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* 21. If you had testing, did Dr Motyka's office provide you with access to your results?

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* 22. During your most recent visit, were receptionists at For Women, PA’s office as helpful, courteous and respectful as you thought they should be?

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* 23. During your most recent visit, were the medical assistants as helpful, courteous, and respectful and you thought they should be

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* 24. Would you recommend Dr. Elizabeth Motyka’s office to your family and friends?

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* 25. What is your age?

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* 26. Are you male, female, non-binary, or prefer not to identify ?

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

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* 28. Our office believes strongly in and is committed to eliminating disparities in health care and to confronting implicit and explicit bias and racism. This means recognizing and examining our own prejudice and bias and addressing the way in which health care systems perpetuate inequality. Have you ever experienced racism while receiving care at our office? If so, please let us know in the comment section how we can best correct our actions.

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* 29. What is your ethnicity? (Please select all that apply.)

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* 30. Please leave any comments or suggestions you would like to share 

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