Question Title * 1. Is Asheville Women's Medical Center the provider you usually see if you need a check-up, want advice about a OB or GYN health problem ? Yes No Question Title * 2. How long have you been going to Asheville Women's Medical Center? Less than 6 months At least 6 months but less than 1 year At least 1 year but less than 3 years At least 3 years but less than 5 years 5 years or more Question Title * 3. In the last 12 months, how many times did you visit Asheville Women's Medical Center? None 1 time 2 3 4 5 to 9 10 or more times Question Title * 4. In the last 12 months, did you phone Asheville Women's Medical Center’s office to get an appointment for an illness, injury, or condition that needed care right away? Yes No Question Title * 5. In the last 12 months, when you phoned Asheville Women's Medical Center’s office to get an appointment for care you needed right away, how often did you get an appointment as soon as you needed? Never Sometimes Usually Always Question Title * 6. In the last 12 months, did you make any appointments for a check-up or routine care with Asheville Women's Medical Center? Yes No Question Title * 7. In the last 12 months, when you made an appointment for a check-up or routine care with Asheville Women's Medical Center, how often did you get an appointment as soon as you needed? Never Sometimes Usually Always Question Title * 8. In the last 12 months, did you phone Asheville Women's Medical Center’s office with a medical question during regular office hours? Yes No Question Title * 9. In the last 12 months, when you phoned Asheville Women's Medical Center’s office during regular office hours, how often did you get an answer to your medical question that same day? Never Sometimes Usually Always Question Title * 10. In the last 12 months, did you phone Asheville Women's Medical Center’s office with a medical question after regular office hours? Yes No Question Title * 11. In the last 12 months, when you phoned Asheville Women's Medical Center’s office after regular office hours, how often did you get an answer to your medical question as soon as you needed? Never Sometimes Usually Always Question Title * 12. Wait time includes time spent in the waiting room and exam room. In the last 12 months, how often did you see Asheville Women's Medical Center within 15 minutes of your appointment time? Never Sometimes Usually Always Question Title * 13. How long has it been since your most recent visit with Asheville Women's Medical Center? Less than 1 month At least 1 month but less than 3 months At least 3 months but less than 6 months At least 6 months but less than 12 months 12 months or more Question Title * 14. Wait time includes time spent in the waiting room and exam room. During your most recent visit, did you see Asheville Women's Medical Center within 15 minutes of your appointment time? Yes No Question Title * 15. During your most recent visit, did Asheville Women's Medical Center explain things in a way that was easy to understand? Yes, definitely Yes, somewhat No Question Title * 16. During your most recent visit, did Asheville Women's Medical Center listen carefully to you? Yes, definitely Yes, somewhat No Question Title * 17. During your most recent visit, did you talk with Asheville Women's Medical Center about any health questions or concerns? Yes No Question Title * 18. During your most recent visit, did Asheville Women's Medical Center give you easy to understand information about these health questions or concerns? Yes, definitely Yes, somewhat No Question Title * 19. During your most recent visit, did Asheville Women's Medical Center seem to know the important information about your medical history? Yes, definitely Yes, somewhat No Question Title * 20. During your most recent visit, did Asheville Women's Medical Center show respect for what you had to say? Yes, definitely Yes, somewhat No Question Title * 21. During your most recent visit, did Asheville Women's Medical Center spend enough time with you? Yes, definitely Yes, somewhat No Question Title * 22. During your most recent visit, did Asheville Women's Medical Center order a blood test, x-ray, or other test for you? Yes No Question Title * 23. Did someone from Asheville Women's Medical Center’s office follow up to give you those results? Yes No Question Title * 24. Using any number from 0 to 10, where 0 is the worst provider possible and 10 is the best provider possible, what number would you use to rate Asheville Women's Medical Center? 10 Best provider possible 9 8 7 6 5 4 3 2 1 0 Worst provider possible . . 10 Best provider possible . 9 . 8 . 7 . 6 . 5 . 4 . 3 . 2 . 1 . 0 Worst provider possible Question Title * 25. Would you recommend Asheville Women's Medical Center’s office to your family and friends? Yes, definitely Yes, somewhat No Question Title * 26. During your most recent visit, were clerks and receptionists at Asheville Women's Medical Center’s office as helpful as you thought they should be? Yes, definitely Yes, somewhat No Question Title * 27. During your most recent visit, did clerks and receptionists at Asheville Women's Medical Center’s office treat you with courtesy and respect? Yes, definitely Yes, somewhat No Question Title * 28. In general, how would you rate your overall health? Excellent Very good Good Fair Poor Question Title * 29. What is your age? 18 to 24 25 to 34 35 to 44 45 to 54 55 to 64 65 to 74 75 or older Question Title * 30. What is the highest grade or level of school that you have completed? 8th grade or less Some high school, but did not graduate High school graduate or GED Some college or 2-year degree 4-year college graduate More than 4-year college degree Question Title * 31. Are you of Hispanic or Latino origin or descent? Yes, Hispanic or Latino No, not Hispanic or Latino Question Title * 32. What is your race? Mark one or more. White Black or African American Asian Native Hawaiian or Other Pacific Islander American Indian or Alaska Native Other Prefer not to answer Question Title * 33. Did someone help you complete this survey? If no, skip to question 35 Yes No Question Title * 34. How did that person help you? Mark one or more. Read the questions to me Wrote down the answers I gave Answered the questions for me Translated the questions into my language Helped in some other way Question Title * 35. Would you be interested in using our "Credit Card on File" option to cover your out of pocket healthcare expenses ? This option allows you to securely store your credit or HSA card information (no employee has any access to your data) & allows you ease in paying deductibles & copays after your insurance processes your claim. Yes No Question Title * 36. Which healthcare provider do you usually see ? Lydia M. Jeffries, MD Michelle A. Simmons, MD Christi G. Hunt, MD J. Robert Wright, MD Eric M. Hawes, MD Mary Katherine Goodwin, MD Catherine T. "Kirby" Kurtz, MD Jon W. Larrabee, MD Amy Burris, OGNP Alexis Wilson, NP I only come to your office for my mammogram Question Title * 37. What location do you usually visit ? Asheville Office - 143 Asheland Ave, Asheville, NC South Office - 310 Long Shoals Rd, Ste 202, Arden, NC Question Title * 38. Were you aware that Asheville Women's offers state of the art 3D Mammography and Automated Whole Breast Ultrasound (for patients with dense breast tissue) at our Asheland Ave location ? Yes No No, but I'll be calling for more information ! Question Title * 39. Do you have any additional comments or concerns ? Done
