BIRTH AND WOMEN'S CARE PATIENT SATISFACTION SURVEY

* 1. Our records show that you got care from Birth and Women's Care. Is that right?

* 2. Who did you see at your most recent visit?

* 3. How long have you been going to Birth and Women's Care?

* 4. In the last 12 months, did you phone Birth and Women's Care’s office to get an appointment for an illness, injury, or condition that needed care right away?

* 5. In the last 12 months, when you phoned Birth and Women's Care’s office to get an appointment for care you needed right away, how often did you get an appointment as soon as you needed?

* 6. In the last 12 months, when you made an appointment for a check-up or routine care with Birth and Women's Care, how often did you get an appointment as soon as you needed?

* 7. What is your age?

* 8. What is the highest grade or level of school that you have completed?

* 9. Wait time includes time spent in the waiting room and exam room. In the last 12 months, how often did you see Birth and Women's Care within 15 minutes of your appointment time?

* 10. Using any number from 0 to 10, where 0 is the worst patient portal experience and 10 being the best patient portal experience how do you rate the Patient Portal for ease of use?

* 11. Have you used the Patient Portal to request a medication or medication refill?

* 12. Have you used the Patient Portal to send a message to the office or clinical staff?

* 13. In the last 12 months, did you phone Birth and Women's Care’s office with a medical question during regular office hours?

* 14. In the last 12 months, when you phoned Birth and Women's Care's office during regular office hours, how often did you get an answer to your medical question that same day?

* 15. In the last 12 months, did you phone Birth and Women's Care’s office with a medical question after regular office hours?

* 16. In the last 12 months, when you phoned Birth and Women's Care’s office after regular office hours, how often did you get an answer to your medical question as soon as you needed?

* 17. How long has it been since your most recent visit with Birth and Women's Care?

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

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

* 20. During your most recent visit, did your healthcare provider seem to know the important information about your medical history?

* 21. During your most recent visit, did your healthcare provider show respect for what you had to say?

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

* 23. During your most recent visit, did your healthcare provider order a blood test, x-ray, or other test for you?

* 24. During your most recent visit, were clerks and receptionists at Birth and Women's Care’s office as helpful as you thought they should be?

* 25. In the last 12 months, how many times did you visit Birth and Women's Care?

* 26. Have you used the Patient Portal to review your medical information or lab results

* 27. Did someone from Birth and Women's Care’s office follow up to give you those results?

* 28. 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
.

* 29. Are you of Hispanic or Latino origin or descent?

* 30. What is your race? Mark one or more.

* 31. Using any number from 0 to 10, where 0 is the worst experience possible and 10 is the best experience possible, what number would you use to rate Birth and Women's Care coordination of any referrals you required?

  10 Best experience possible 9 8 7 6 5 4 3 2 1 0 Worst experience possible
.

* 32. Would you recommend Birth and Women's Care’s office to your family and friends?

* 33. Using any number from 0 to 10, where 0 is the worst experience possible and 10 is the best experience possible, what number would you use to rate Birth and Women's Care?

  10 Best experience possible 9 8 7 6 5 4 3 2 1 0 Worst experience possible
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