WHS Customer Satisfaction Survey

Women's Health Services Client Satisfaction Survey

We're committed to monitoring the quality of the services and products we provide, as part of an ongoing improvement process. We would appreciate your feedback on our performance, and you opinions and reviews are very helpful in our planning process. If you have any concerns, please contact Jenny at 877-611-7600.

None of the following questions are required, however, the more questions you can answer, the more helpful your feedback will be.

All submissions are anonymous.

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* 1. Which clinic location did you most recently visit?

Cameron

Trenton

Bethany

Brookfield

Chillicothe

Unionville

Carrollton

Richmond

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* 2. Please select the services you have received through our clinic(s).

First Time Visit

Annual Exam

Pill Pick-up

Pregnancy Test

Depo Injection

Problem Visit

STD Screening

Other

If "Other", please comment

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* 3. Are you:

Female

Male

What is your age?

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* 4. When calling for an appointment:

	Excellent	Very Good	Good	Fair	Poor	N/A
The telephone was answered promptly	The telephone was answered promptly Excellent	The telephone was answered promptly Very Good	The telephone was answered promptly Good	The telephone was answered promptly Fair	The telephone was answered promptly Poor	The telephone was answered promptly N/A
You were quickly connected to the appropriate staff member	You were quickly connected to the appropriate staff member Excellent	You were quickly connected to the appropriate staff member Very Good	You were quickly connected to the appropriate staff member Good	You were quickly connected to the appropriate staff member Fair	You were quickly connected to the appropriate staff member Poor	You were quickly connected to the appropriate staff member N/A
The appointment scheduler was sensitive to your needs	The appointment scheduler was sensitive to your needs Excellent	The appointment scheduler was sensitive to your needs Very Good	The appointment scheduler was sensitive to your needs Good	The appointment scheduler was sensitive to your needs Fair	The appointment scheduler was sensitive to your needs Poor	The appointment scheduler was sensitive to your needs N/A

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* 5. During today's visit:

	Excellent	Very Good	Good	Fair	Poor	N/A
The receptionist was friendly	The receptionist was friendly Excellent	The receptionist was friendly Very Good	The receptionist was friendly Good	The receptionist was friendly Fair	The receptionist was friendly Poor	The receptionist was friendly N/A
You were waited on promptly	You were waited on promptly Excellent	You were waited on promptly Very Good	You were waited on promptly Good	You were waited on promptly Fair	You were waited on promptly Poor	You were waited on promptly N/A
The interviewer was sensitive to your needs	The interviewer was sensitive to your needs Excellent	The interviewer was sensitive to your needs Very Good	The interviewer was sensitive to your needs Good	The interviewer was sensitive to your needs Fair	The interviewer was sensitive to your needs Poor	The interviewer was sensitive to your needs N/A
The time with the examiner was long enough to meet your needs	The time with the examiner was long enough to meet your needs Excellent	The time with the examiner was long enough to meet your needs Very Good	The time with the examiner was long enough to meet your needs Good	The time with the examiner was long enough to meet your needs Fair	The time with the examiner was long enough to meet your needs Poor	The time with the examiner was long enough to meet your needs N/A
You were seen promptly for pill pick-up/depo injection	You were seen promptly for pill pick-up/depo injection Excellent	You were seen promptly for pill pick-up/depo injection Very Good	You were seen promptly for pill pick-up/depo injection Good	You were seen promptly for pill pick-up/depo injection Fair	You were seen promptly for pill pick-up/depo injection Poor	You were seen promptly for pill pick-up/depo injection N/A
Your payment was taken promptly after your exam	Your payment was taken promptly after your exam Excellent	Your payment was taken promptly after your exam Very Good	Your payment was taken promptly after your exam Good	Your payment was taken promptly after your exam Fair	Your payment was taken promptly after your exam Poor	Your payment was taken promptly after your exam N/A

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* 6. Were the clinic hours convenient for you?

Yes

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* 7. Was the clinic location appropriate for your needs? (e.g. easy to find, clean, safe, private, etc)

Yes

If you answered no, please explain

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* 8. Would you recommend GHCAA Women's Health Services to your friends?

Yes

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* 9. How would you rate the Women's Health Services program overall?

Excellent

Good

Neutral

Poor

Unacceptable

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* 1. Which clinic location did you most recently visit?

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* 2. Please select the services you have received through our clinic(s).

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* 3. Are you:

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* 4. When calling for an appointment:

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* 5. During today's visit:

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* 6. Were the clinic hours convenient for you?

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* 7. Was the clinic location appropriate for your needs? (e.g. easy to find, clean, safe, private, etc)

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* 8. Would you recommend GHCAA Women's Health Services to your friends?

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* 9. How would you rate the Women's Health Services program overall?

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* 10. If you have any suggestions as to how we can improve our level of service to you, please tell us in the box below.