Carteret Ob-Gyn Patient Satisfaction Survey * 1. Our records show that you received care from your heathcare provider. Please choose the provider that you received care from. Erin Wax, FNP Marie Frey, FNP Tara Mitchell, FNP Nicole D'Andrea, MD Olivia McCallum, MD Thomas Vradelis, MD Theresa Johnson, MD Sheli Garrett-Albaugh, DO Caitlin Dammin, PA Megan Lambeth, DO * 2. Which location was your appointment? Morehead City Office Swansboro Office * 3. How long have you been going to your healthcare provider? 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 These questions ask about your own health care. Please answer questions according to your most recent office visit. Do NOT include care you received when you stayed overnight in a hospital. Do NOT include the times you went for dental care visits. * 4. When scheduling your most recent appointment, was your appointment scheduled within a reasonable time frame? Yes No * 5. Was your most recent appointment for a check-up or routine care with your healthcare provider or for an illness, injury, or condition other than routine care? Check up/Routine care Illness/Injury/Condition * 6. Did you get a reminder from your provider's office for your most recent appointment? Yes No * 7. Wait time includes time spent in the waiting room and exam room. How long was your wait for your most recent appointment? 0 - 15 minutes 15 - 30 minutes 30 - 60 minutes Greater than 60 minutes * 8. At your most recent appointment, did anyone in your provider's office verify all the prescription and over-the-counter medicines you are taking? Yes No * 9. Did your healthcare provider give you easy to understand information about your health questions or concerns during your most recent appointment? Yes No * 10. In the last 6 months, how often did your healthcare provider spend enough time with you? Never Sometimes Usually Always * 11. In the last 6 months, when your healthcare provider ordered a blood test, x-ray, or other test for you, how often did you receive results within 1 -2 weeks? Never Sometimes Usually Always * 12. When you talked about starting or stopping a prescription medicine, how much did your provider talk about the reasons you might want or not want to take a medicine? Not at all A little Some A lot * 13. When you phoned your healthcare provider’s office during regular office hours, how often did you get an answer to your medical question that same day? Never Sometimes Usually Always * 14. In the last 6 months, if you were seen by a specialist, was the provider named in Question 1 informed and up-to-date about the care you received from the specialist? Yes No * 15. In the last 6 months, how often were you able to get the care you needed from this provider's office during evenings, weekends, or holidays? Never Sometimes Usually Always * 16. In the last 6 months, did anyone in your provider's office talk with you about specific goals for your health? Yes No * 17. In the last 6 months, did anyone in this provider's office ask you if there are things that make it hard for you to take care of your health? Yes No * 18. 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 your healthcare provider? 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 * 19. 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 * 20. What is the highest level of school that you have completed? 8th grade or less Some high school, but did not graduate High school diploma or GED Some college or 2-year degree 4-year college graduate More than 4-year college graduate * 21. What is your race? Mark one or more. White Hispanic or Latino origin Black or African America Asian Native Hawaiian or Other Pacific Islander American Indian or Alaska Native Other * 22. Comments.This survey is anonymous. If you would like a return call concerning your appointment, please enter your name and contact information and someone will contact you. * 23. How did hear about our office? Radio Television Newspaper Internet/Facebook Physician Referral Patient Referral/Friend Signage Brochure Walk-in Other Done
