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.

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* 1. Patient's Age

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* 2. I am a

Patient

Patient's Parent, Caregiver, or Guardian

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* 3. Patient's Gender

Male

Female

Other

Prefer not to answer

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* 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

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* 5. Is the Patient Hispanic, Latino, or Spanish?

Yes

Prefer not to answer

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* 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

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* 7. At which office do you typically see your hematologist?

Lipson Cancer Center

Mary M. Gooley Hemophilia Center

Other

I don't know

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* 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

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* 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

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* 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:

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* 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	Time spent waiting in the waiting room at the Center No wait (Less than 1 minute)	Time spent waiting in the waiting room at the Center Short Wait (Less than 15 minutes)	Time spent waiting in the waiting room at the Center Long Wait (More than 15 minutes)
Time spent waiting in the treatment area for a phlebotomy	Time spent waiting in the treatment area for a phlebotomy No wait (Less than 1 minute)	Time spent waiting in the treatment area for a phlebotomy Short Wait (Less than 15 minutes)	Time spent waiting in the treatment area for a phlebotomy Long Wait (More than 15 minutes)
Time spent waiting for my hematologist	Time spent waiting for my hematologist No wait (Less than 1 minute)	Time spent waiting for my hematologist Short Wait (Less than 15 minutes)	Time spent waiting for my hematologist Long Wait (More than 15 minutes)

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* 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	Receptionist/Office Administrator Always Satisfied	Receptionist/Office Administrator Usually Satisfied	Receptionist/Office Administrator Sometimes Satisfied	Receptionist/Office Administrator Never Satisfied	Receptionist/Office Administrator Not Applicable
Nurse	Nurse Always Satisfied	Nurse Usually Satisfied	Nurse Sometimes Satisfied	Nurse Never Satisfied	Nurse Not Applicable
Hematologist	Hematologist Always Satisfied	Hematologist Usually Satisfied	Hematologist Sometimes Satisfied	Hematologist Never Satisfied	Hematologist Not Applicable
Social Worker	Social Worker Always Satisfied	Social Worker Usually Satisfied	Social Worker Sometimes Satisfied	Social Worker Never Satisfied	Social Worker Not Applicable

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* 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?	Was it easy to make an appointment with your hematologist? Always	Was it easy to make an appointment with your hematologist? Usually	Was it easy to make an appointment with your hematologist? Sometimes	Was it easy to make an appointment with your hematologist? Never	Was it easy to make an appointment with your hematologist? Not Applicable
Was it easy to make an appointment for a therapeutic phlebotomy?	Was it easy to make an appointment for a therapeutic phlebotomy? Always	Was it easy to make an appointment for a therapeutic phlebotomy? Usually	Was it easy to make an appointment for a therapeutic phlebotomy? Sometimes	Was it easy to make an appointment for a therapeutic phlebotomy? Never	Was it easy to make an appointment for a therapeutic phlebotomy? Not Applicable
Did medical staff explain things in a way that was easy to understand?	Did medical staff explain things in a way that was easy to understand? Always	Did medical staff explain things in a way that was easy to understand? Usually	Did medical staff explain things in a way that was easy to understand? Sometimes	Did medical staff explain things in a way that was easy to understand? Never	Did medical staff explain things in a way that was easy to understand? Not Applicable
Did medical staff spend enough time with you (or your child)?	Did medical staff spend enough time with you (or your child)? Always	Did medical staff spend enough time with you (or your child)? Usually	Did medical staff spend enough time with you (or your child)? Sometimes	Did medical staff spend enough time with you (or your child)? Never	Did medical staff spend enough time with you (or your child)? Not Applicable
Did staff treat you (or your child) with respect?	Did staff treat you (or your child) with respect? Always	Did staff treat you (or your child) with respect? Usually	Did staff treat you (or your child) with respect? Sometimes	Did staff treat you (or your child) with respect? Never	Did staff treat you (or your child) with respect? Not Applicable
Did clinical staff involve you (or your child) in decisions about your care?	Did clinical staff involve you (or your child) in decisions about your care? Always	Did clinical staff involve you (or your child) in decisions about your care? Usually	Did clinical staff involve you (or your child) in decisions about your care? Sometimes	Did clinical staff involve you (or your child) in decisions about your care? Never	Did clinical staff involve you (or your child) in decisions about your care? Not Applicable

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* 14. How educated do you feel regarding your diagnosis and treatment plan?

Not Very

Somewhat

Very

Not Very

Somewhat

Very

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* 15. Do you currently have any health insurance barriers or concerns about the costs associated with your hemochromatosis care?

Yes

If you chose yes, please explain:

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* 16. In general, how satisfied were you with your overall care at the Center?

Always Satsified

Usually Satisfied

Sometimes Satisfied

Never Satisfied

2022 Hemochromatosis & Iron Overload Patient Satisfaction Survey

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* 1. Patient's Age

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* 2. I am a

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* 3. Patient's Gender

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* 4. Patient's Race

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* 5. Is the Patient Hispanic, Latino, or Spanish?

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* 6. Who is your primary hematologist or physician who manages your care?

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* 7. At which office do you typically see your hematologist?

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* 8. How long have you been coming to the Mary M. Gooley Hemophilia Center?

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* 9. How often do you come to the Mary M. Gooley Hemophilia Center for your phlebotomies?

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* 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:

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* 11. Please rate the typical time spent waiting for services:

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* 12. How would you rate your level of satisfaction with the Center's staff?

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* 13. Please rate your satisfaction with care and services you receive at the Center:

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* 14. How educated do you feel regarding your diagnosis and treatment plan?

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* 15. Do you currently have any health insurance barriers or concerns about the costs associated with your hemochromatosis care?

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* 16. In general, how satisfied were you with your overall care at the Center?

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* 17. Please share any comments or suggestions below: