Thank you for allowing Women's Health Center to care for you!  How was your recent visit?

All information you provide is secure and HIPAA compliant.

What was the date of your visit?

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* 2. What was the date of your visit?

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Were you able to get an appointment time as soon as you needed?

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* 3. Were you able to get an appointment time as soon as you needed?

When you arrived for your appointment was the receptionist friendly and attentive?

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* 4. When you arrived for your appointment was the receptionist friendly and attentive?

Wait time includes time spent in the waiting room and exam room. During your most recent visit, was your wait time acceptable to you?

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* 5. Wait time includes time spent in the waiting room and exam room. During your most recent visit, was your wait time acceptable to you?

During your most recent visit, did your healthcare provider listen carefully to you?

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* 6. During your most recent visit, did your healthcare provider listen carefully to you?

During your most recent visit, did your health care provider show respect for what you had to say?

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* 7. During your most recent visit, did your health care provider show respect for what you had to say?

During your most recent visit, did your healthcare provider explain things in a way that was easy for you to understand?

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* 8. During your most recent visit, did your healthcare provider explain things in a way that was easy for you to understand?

During your most recent visit, did your healthcare provider spend enough time with you?

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* 9. During your most recent visit, did your healthcare provider spend enough time with you?

Would you recommend Women's Health Center to your family and friends?

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* 10. Would you recommend Women's Health Center to your family and friends?

How did you hear about Women's Health Center? Please include name of newpaper, magazine or radio station, if applicable.

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* 11. How did you hear about Women's Health Center? Please include name of newpaper, magazine or radio station, if applicable.

Let us know any comments you have or how we may improve your patient experience. Include your name if you would like a personal reply.

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* 12. Let us know any comments you have or how we may improve your patient experience. Include your name if you would like a personal reply.

Would you like to enter a monthly drawing for a $50 gift certificate at a local business? If yes, please provide name.

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* 13. Would you like to enter a monthly drawing for a $50 gift certificate at a local business? If yes, please provide name.

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