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* 1. Overall, how satisfied or dissatisfied were you with your last visit to our office?

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* 2. Which provider did you see at your last visit to our office?  Please select all that apply.

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* 3. How convenient was the appointment time you were able to get?

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* 4. Overall, how satisfied or dissatisfied were you with your scheduling experience?

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* 5. Overall, how would you rate the service you received from our entire staff at our office?

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* 6. How comfortable was the lobby and waiting area?

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* 7. Did your appointment with your provider start early, late or on time?

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* 8. Overall, how would you rate the care you received from your provider?

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* 9. How well did your provider listen to your needs, questions, and/or concerns?

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* 10. How well did your provider answer your questions?

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* 11. How well did your provider explain your treatment options?

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* 12. How well did your provider explain your follow-up care?

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* 13. How satisfied or dissatisfied were you with the amount of time your provider spent with you addressing your needs?

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* 14. How likely is it that you would recommend The Women's Health Group to a friend or colleague?

Not at all likely
Extremely likely

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* 15. Is there anything we could have done to improve your last visit?

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* 16. Please leave your contact information if you would like to speak with someone about your recent visit to our office.

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