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2022 Hemochromatosis & Iron Overload Patient Satisfaction Survey
Please take a few moments to share your honest feedback regarding services you receive at the Mary M. Gooley Hemophilia Center.
OK
1.
Patient's Age
2.
I am a
Patient
Patient's Parent, Caregiver, or Guardian
3.
Patient's Gender
Male
Female
Other
Prefer not to answer
4.
Patient's Race
American Indian or Alaskan Native
Asian or Asian American
Black or African American
Native Hawaiian or other Pacific Islander
White or Caucasian
Another race
Prefer not to answer
5.
Is the Patient Hispanic, Latino, or Spanish?
Yes
No
Prefer not to answer
6.
Who is your primary hematologist or physician who manages your care?
Dr. Imran
Dr. Jamshed
Dr. Kouides
Dr. Phatak
Dr. Reid
Dr. Sham
Other
I don't know
7.
At which office do you typically see your hematologist?
Lipson Cancer Center
Mary M. Gooley Hemophilia Center
Other
I don't know
8.
How long have you been coming to the Mary M. Gooley Hemophilia Center?
Less than a year
1-5 years
5-10 years
More than 10 years
I don't know
9.
How often do you come to the Mary M. Gooley Hemophilia Center for your phlebotomies?
1-2 times per year
3-4 times per year
More than 4 times per year
I don't know
I don't get my phlebotomies at the Center
10.
If you don't receive your phlebotomies at the Mary M. Gooley Hemophilia Center, please share where you go for your treatments and why:
11.
Please rate the typical time spent waiting for services:
No wait (Less than 1 minute)
Short Wait (Less than 15 minutes)
Long Wait (More than 15 minutes)
Time spent waiting in the waiting room at the Center
No wait (Less than 1 minute)
Short Wait (Less than 15 minutes)
Long Wait (More than 15 minutes)
Time spent waiting in the treatment area for a phlebotomy
No wait (Less than 1 minute)
Short Wait (Less than 15 minutes)
Long Wait (More than 15 minutes)
Time spent waiting for my hematologist
No wait (Less than 1 minute)
Short Wait (Less than 15 minutes)
Long Wait (More than 15 minutes)
12.
How would you rate your level of satisfaction with the Center's staff?
Always Satisfied
Usually Satisfied
Sometimes Satisfied
Never Satisfied
Not Applicable
Receptionist/Office Administrator
Always Satisfied
Usually Satisfied
Sometimes Satisfied
Never Satisfied
Not Applicable
Nurse
Always Satisfied
Usually Satisfied
Sometimes Satisfied
Never Satisfied
Not Applicable
Hematologist
Always Satisfied
Usually Satisfied
Sometimes Satisfied
Never Satisfied
Not Applicable
Social Worker
Always Satisfied
Usually Satisfied
Sometimes Satisfied
Never Satisfied
Not Applicable
13.
Please rate your satisfaction with care and services you receive at the Center:
Always
Usually
Sometimes
Never
Not Applicable
Was it easy to make an appointment with your hematologist?
Always
Usually
Sometimes
Never
Not Applicable
Was it easy to make an appointment for a therapeutic phlebotomy?
Always
Usually
Sometimes
Never
Not Applicable
Did medical staff explain things in a way that was easy to understand?
Always
Usually
Sometimes
Never
Not Applicable
Did medical staff spend enough time with you (or your child)?
Always
Usually
Sometimes
Never
Not Applicable
Did staff treat you (or your child) with respect?
Always
Usually
Sometimes
Never
Not Applicable
Did clinical staff involve you (or your child) in decisions about your care?
Always
Usually
Sometimes
Never
Not Applicable
14.
How educated do you feel regarding your diagnosis and treatment plan?
Not Very
Somewhat
Very
Not Very
Somewhat
Very
15.
Do you currently have any health insurance barriers or concerns about the costs associated with your hemochromatosis care?
Yes
No
If you chose yes, please explain:
16.
In general, how satisfied were you with your overall care at the Center?
Always Satsified
Usually Satisfied
Sometimes Satisfied
Never Satisfied
17.
Please share any comments or suggestions below:
Current Progress,
0 of 17 answered
