OB Patient Satisfaction Survey Question Title * 1. Which provider did you see today? Dr Ahadi Dr Mossallam Dr Khaghany Dr Pakideh Beth Junkin Other (please specify) Question Title * 2. I am able to get through to the office on the phone during office hours Always Sometimes Rarely Never Question Title * 3. In the last 12 months, when you phoned your healthcare provider’s office after regular office hours, how often did you get an answer to your medical question as soon as you needed? Never Sometimes Usually Always N/A Question Title * 4. How convenient was the appointment time you were able to get? Extremely convenient Somewhat convenient Not at all convenient If not, what would make it more convenient? Question Title * 5. How easy is it to schedule urgent appointments with your provider when you're ill? Extremely easy Very easy Moderately easy Slightly easy Not at all easy N/A Question Title * 6. How courteous and helpful was the receptionist when you arrived at our office? Extremely Very Somewhat Not very Not at all Question Title * 7. How friendly was the clinical staff during your visit? Extremely friendly Very friendly Somewhat friendly Not so friendly Not at all friendly Question Title * 8. Overall, how often do you wait more than 15 minutes to see your provider? (Wait time includes time spent in the waiting room and exam room.) Always Most of the time About half of the time Once in a while Never Question Title * 9. How satisfied or dissatisfied were you with the amount of time your provider spent with you addressing your needs? Very satisfied Somewhat satisfied Neither satisfied nor dissatisfied Somewhat dissatisfied Very dissatisfied Question Title * 10. Were your needs met at this visit? Extremely well Very well Somewhat well Not so well Not at all Question Title * 11. Did you observe the medical staff wash their hands or use hand sanitizer? Yes No Question Title * 12. Did anyone talk to you about the medication you take? Yes No Question Title * 13. Were you asked if you had visits with other health care providers since your last visit? Yes No Question Title * 14. Did anyone help you make an appointment with a specialty provider if necessary? Yes No NA Question Title * 15. Have we ever given you information about FMC being your medical home? Yes No Question Title * 16. Have we ever helped you find other community resources you might need that FMC does not provide? Yes No NA Question Title * 17. Do you feel what you pay for your care is reasonable? Extremely reasonable Very reasonable Somewhat reasonable Not very reasonable Not at all reasonable Question Title * 18. May we contact you for further input regarding your thoughts on FMC? Yes No If yes, please supply preferred contact information Question Title * 19. Would you recommend FMC to your friends and family? Definitely no Probably no Probably yes Definitely yes Question Title * 20. How did you hear about Family Medical Center? Family/Friends Direct mailing/Letter from FMC Newspaper/Magazine Ad Internet Search Health Insurance Health Department/WIC/Monroe County Community Mental Health Hospital School/Work Community Event Other (please specify) Question Title * 21. Do you have any comments or suggestions? Question Title * 22. Is this your first visit with Family Medical Center? Yes No Done