PAC Exit Survey

Client Satisfaction Survey

The staff and volunteers at Pregnancy Aid Clinic strive to provide high clinical and service quality. One method of evaluating our performance in these two important areas is to measure patient satisfaction. PAC has established a formal evaluation process, which consists of compiling the results of this survey and communicating this feedback to the physicians, personnel and Board of Directors. Your comments are appreciated and valued.

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* 1. Date of Visit

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* 2. Which location?

Forest Park, GA

Roswell, GA

Atlanta, GA

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* 3. Was this the first visit to this facility?

Yes

No, I have been to this facility before

No, I have been to one of your other locations

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* 4. If yes, how did you hear about us?

Online/Google search

Referral from friend/family

Referral from other agency

Other (please specify)

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* 5. Scheduling

	Poor	Fair	Good	Very Good	Excellent	N/A
Ease and efficiency of making your appointment	Ease and efficiency of making your appointment Poor	Ease and efficiency of making your appointment Fair	Ease and efficiency of making your appointment Good	Ease and efficiency of making your appointment Very Good	Ease and efficiency of making your appointment Excellent	Ease and efficiency of making your appointment N/A
Website is user friendly	Website is user friendly Poor	Website is user friendly Fair	Website is user friendly Good	Website is user friendly Very Good	Website is user friendly Excellent	Website is user friendly N/A
Appointment available within reasonable amount of time	Appointment available within reasonable amount of time Poor	Appointment available within reasonable amount of time Fair	Appointment available within reasonable amount of time Good	Appointment available within reasonable amount of time Very Good	Appointment available within reasonable amount of time Excellent	Appointment available within reasonable amount of time N/A
Person who scheduled your appointment was efficient, courteous and helpful	Person who scheduled your appointment was efficient, courteous and helpful Poor	Person who scheduled your appointment was efficient, courteous and helpful Fair	Person who scheduled your appointment was efficient, courteous and helpful Good	Person who scheduled your appointment was efficient, courteous and helpful Very Good	Person who scheduled your appointment was efficient, courteous and helpful Excellent	Person who scheduled your appointment was efficient, courteous and helpful N/A
Convenience of appointment times available	Convenience of appointment times available Poor	Convenience of appointment times available Fair	Convenience of appointment times available Good	Convenience of appointment times available Very Good	Convenience of appointment times available Excellent	Convenience of appointment times available N/A

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* 6. Reception

	Poor	Fair	Good	Very Good	Excellent	N/A
Greeted in a timely and courteous manner upon arrival for appointment	Greeted in a timely and courteous manner upon arrival for appointment Poor	Greeted in a timely and courteous manner upon arrival for appointment Fair	Greeted in a timely and courteous manner upon arrival for appointment Good	Greeted in a timely and courteous manner upon arrival for appointment Very Good	Greeted in a timely and courteous manner upon arrival for appointment Excellent	Greeted in a timely and courteous manner upon arrival for appointment N/A
Efficiency & friendliness demonstrated by front desk personnel	Efficiency & friendliness demonstrated by front desk personnel Poor	Efficiency & friendliness demonstrated by front desk personnel Fair	Efficiency & friendliness demonstrated by front desk personnel Good	Efficiency & friendliness demonstrated by front desk personnel Very Good	Efficiency & friendliness demonstrated by front desk personnel Excellent	Efficiency & friendliness demonstrated by front desk personnel N/A
Reception/waiting room area was clean and comfortable	Reception/waiting room area was clean and comfortable Poor	Reception/waiting room area was clean and comfortable Fair	Reception/waiting room area was clean and comfortable Good	Reception/waiting room area was clean and comfortable Very Good	Reception/waiting room area was clean and comfortable Excellent	Reception/waiting room area was clean and comfortable N/A
The paperwork was user friendly	The paperwork was user friendly Poor	The paperwork was user friendly Fair	The paperwork was user friendly Good	The paperwork was user friendly Very Good	The paperwork was user friendly Excellent	The paperwork was user friendly N/A

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* 7. Access to Care

	Poor	Fair	Good	Very Good	Excellent	N/A
Waiting time in reception/waiting room area	Waiting time in reception/waiting room area Poor	Waiting time in reception/waiting room area Fair	Waiting time in reception/waiting room area Good	Waiting time in reception/waiting room area Very Good	Waiting time in reception/waiting room area Excellent	Waiting time in reception/waiting room area N/A
Waiting time in exam room	Waiting time in exam room Poor	Waiting time in exam room Fair	Waiting time in exam room Good	Waiting time in exam room Very Good	Waiting time in exam room Excellent	Waiting time in exam room N/A
Convenience of facility location and parking facilities	Convenience of facility location and parking facilities Poor	Convenience of facility location and parking facilities Fair	Convenience of facility location and parking facilities Good	Convenience of facility location and parking facilities Very Good	Convenience of facility location and parking facilities Excellent	Convenience of facility location and parking facilities N/A

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* 8. Client Advocate

	Poor	Fair	Good	Very Good	Excellent	N/A
The Advocate treated me with respect at all times	The Advocate treated me with respect at all times Poor	The Advocate treated me with respect at all times Fair	The Advocate treated me with respect at all times Good	The Advocate treated me with respect at all times Very Good	The Advocate treated me with respect at all times Excellent	The Advocate treated me with respect at all times N/A
The Advocate explained what the materials were about	The Advocate explained what the materials were about Poor	The Advocate explained what the materials were about Fair	The Advocate explained what the materials were about Good	The Advocate explained what the materials were about Very Good	The Advocate explained what the materials were about Excellent	The Advocate explained what the materials were about N/A
The materials were easy to understand	The materials were easy to understand Poor	The materials were easy to understand Fair	The materials were easy to understand Good	The materials were easy to understand Very Good	The materials were easy to understand Excellent	The materials were easy to understand N/A
The Advocate identified my concerns/fears and assisted me in overcoming them	The Advocate identified my concerns/fears and assisted me in overcoming them Poor	The Advocate identified my concerns/fears and assisted me in overcoming them Fair	The Advocate identified my concerns/fears and assisted me in overcoming them Good	The Advocate identified my concerns/fears and assisted me in overcoming them Very Good	The Advocate identified my concerns/fears and assisted me in overcoming them Excellent	The Advocate identified my concerns/fears and assisted me in overcoming them N/A
The Advocate assisted me with community resources	The Advocate assisted me with community resources Poor	The Advocate assisted me with community resources Fair	The Advocate assisted me with community resources Good	The Advocate assisted me with community resources Very Good	The Advocate assisted me with community resources Excellent	The Advocate assisted me with community resources N/A

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* 9. Clinical/Medical Staff

	Poor	Fair	Good	Very Good	Excellent	N/A
Personal manner (courtesy, respect, cheerfulness & professionalism) of the clinical staff	Personal manner (courtesy, respect, cheerfulness & professionalism) of the clinical staff Poor	Personal manner (courtesy, respect, cheerfulness & professionalism) of the clinical staff Fair	Personal manner (courtesy, respect, cheerfulness & professionalism) of the clinical staff Good	Personal manner (courtesy, respect, cheerfulness & professionalism) of the clinical staff Very Good	Personal manner (courtesy, respect, cheerfulness & professionalism) of the clinical staff Excellent	Personal manner (courtesy, respect, cheerfulness & professionalism) of the clinical staff N/A
Level of competency and professionalism demonstrated by the clinical staff during my visit	Level of competency and professionalism demonstrated by the clinical staff during my visit Poor	Level of competency and professionalism demonstrated by the clinical staff during my visit Fair	Level of competency and professionalism demonstrated by the clinical staff during my visit Good	Level of competency and professionalism demonstrated by the clinical staff during my visit Very Good	Level of competency and professionalism demonstrated by the clinical staff during my visit Excellent	Level of competency and professionalism demonstrated by the clinical staff during my visit N/A
Clinical staff provided clear explanation of each procedure	Clinical staff provided clear explanation of each procedure Poor	Clinical staff provided clear explanation of each procedure Fair	Clinical staff provided clear explanation of each procedure Good	Clinical staff provided clear explanation of each procedure Very Good	Clinical staff provided clear explanation of each procedure Excellent	Clinical staff provided clear explanation of each procedure N/A
Clinical staff demonstrated sensitivity and accommodated for physical limitations	Clinical staff demonstrated sensitivity and accommodated for physical limitations Poor	Clinical staff demonstrated sensitivity and accommodated for physical limitations Fair	Clinical staff demonstrated sensitivity and accommodated for physical limitations Good	Clinical staff demonstrated sensitivity and accommodated for physical limitations Very Good	Clinical staff demonstrated sensitivity and accommodated for physical limitations Excellent	Clinical staff demonstrated sensitivity and accommodated for physical limitations N/A
Cleanliness of exam room and equipment	Cleanliness of exam room and equipment Poor	Cleanliness of exam room and equipment Fair	Cleanliness of exam room and equipment Good	Cleanliness of exam room and equipment Very Good	Cleanliness of exam room and equipment Excellent	Cleanliness of exam room and equipment N/A
Consents were explained and my questions were answered	Consents were explained and my questions were answered Poor	Consents were explained and my questions were answered Fair	Consents were explained and my questions were answered Good	Consents were explained and my questions were answered Very Good	Consents were explained and my questions were answered Excellent	Consents were explained and my questions were answered N/A
Clinical staff's interest - how well he/she listened to you and answered questions	Clinical staff's interest - how well he/she listened to you and answered questions Poor	Clinical staff's interest - how well he/she listened to you and answered questions Fair	Clinical staff's interest - how well he/she listened to you and answered questions Good	Clinical staff's interest - how well he/she listened to you and answered questions Very Good	Clinical staff's interest - how well he/she listened to you and answered questions Excellent	Clinical staff's interest - how well he/she listened to you and answered questions N/A
Clinical staff adequately explained your options	Clinical staff adequately explained your options Poor	Clinical staff adequately explained your options Fair	Clinical staff adequately explained your options Good	Clinical staff adequately explained your options Very Good	Clinical staff adequately explained your options Excellent	Clinical staff adequately explained your options N/A
Clinical staff gave clear instructions regarding follow-up care	Clinical staff gave clear instructions regarding follow-up care Poor	Clinical staff gave clear instructions regarding follow-up care Fair	Clinical staff gave clear instructions regarding follow-up care Good	Clinical staff gave clear instructions regarding follow-up care Very Good	Clinical staff gave clear instructions regarding follow-up care Excellent	Clinical staff gave clear instructions regarding follow-up care N/A
How would you rate the overall visit?	How would you rate the overall visit? Poor	How would you rate the overall visit? Fair	How would you rate the overall visit? Good	How would you rate the overall visit? Very Good	How would you rate the overall visit? Excellent	How would you rate the overall visit? N/A

PAC Exit Survey

Client Satisfaction Survey

Question Title

* 1. Date of Visit

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* 2. Which location?

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* 3. Was this the first visit to this facility?

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* 4. If yes, how did you hear about us?

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* 5. Scheduling

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* 6. Reception

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* 7. Access to Care

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* 8. Client Advocate

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* 9. Clinical/Medical Staff

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* 10. Would you return to PAC?

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* 11. Would you recommend PAC to friends and family

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* 12. What did you like best about your experience at PAC?

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* 13. What did you like least about your experience at PAC?

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* 14. How can we improve our service?