Patient Satisfaction Survey Question Title * 1. Our records show that you recently received care from Williamson Gynecology. Please choose the provider that you saw during this visit: Cile Williamson, MD Amy LaFrenz, WHNP-PC Rachel Thomasson, MSN, ARPN, FNP-C Lab Only Question Title * 2. Is Williamson Gynecology the provider you usually see if you need a check-up, want advice about a health problem, or get sick or hurt? Yes, Williamson Gynecology is my primary provider No, I only go to Williamson Gynecology for gynecological care Question Title * 3. How long have you been going to Williamson Gynecology? Less than 6 months At least 6 months but less than 1 year At least 1 year but less than 3 years At least 3 years but less than 5 years 5 years or more Question Title * 4. In the last 12 months, how many times did you visit Williamson Gynecology? None 1 time 2 3 4 5 to 9 10 or more times Question Title * 5. For your most recent appointment, did you contact Williamson Gynecology’s office to get an appointment for an illness, injury, or condition that needed care right away or to get an appointment for a check-up or routine care? My appointment was for an illness, injury, or condition that needed care right away My appointment was for a check-up or routine care Question Title * 6. When you contacted Williamson Gynecology’s office to get the appointment referenced in question 5, was your appointment scheduled within a reasonable time? Yes No Question Title * 7. In the last 12 months, have you contacted Williamson Gynecology’s office with a medical question during regular office hours? Yes No Question Title * 8. If you have contacted Williamson Gynecology's office with medical question during regular business office hours, how often did you get an answer to your medical question on the same day? Never Sometimes Usually Always I didn't call with a medical question Question Title * 9. In the past 12 months, how often were you able to get the care you needed during evenings, weekends or holidays? Always Usually Sometimes Rarely Never I never had the need for care during evenings, weekends or holidays Question Title * 10. Wait time includes time spent in the waiting room and exam room. How long was your wait time for your most recent visit? 0 - 15 minutes 15 - 30 minutes 30 - 45 minutes 45 - 60 minutes Greater than 60 minutes Question Title * 11. During your most recent visit, did your healthcare provider explain things in a way that was easy to understand? Yes, definitely Yes, somewhat No Question Title * 12. During your most recent visit, did your healthcare provider listen carefully to you? Yes, definitely Yes, somewhat No Question Title * 13. During your most recent visit, did you talk with your healthcare provider about any health questions, health concerns and/or health goals? Yes No Question Title * 14. During your most recent visit, did your healthcare provider give you easy to understand information about these health questions, concerns and/or goals? Yes, definitely Yes, somewhat No Question Title * 15. During your most recent visit, did your healthcare provider seem to know the important information about your medical history? Yes, definitely Yes, somewhat No Question Title * 16. During your most recent visit, did your healthcare provider show respect for what you had to say? Yes, definitely Yes, somewhat No Question Title * 17. During your most recent visit, did your healthcare provider spend enough time with you? Yes, definitely Yes, somewhat No Question Title * 18. During your most recent visit, did your healthcare provider order a blood test, x-ray, or other test for you? Yes No Question Title * 19. If additional testing was ordered, did someone from Williamson Gynecology’s office follow up to give you those results? Yes No Additional testing was not ordered Question Title * 20. 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 . . 10 Best provider possible . 9 . 8 . 7 . 6 . 5 . 4 . 3 . 2 . 1 . 0 Worst provider possible Question Title * 21. Would you recommend Williamson Gynecology’s office to your family and friends? Yes, definitely Yes, somewhat No Question Title * 22. During your most recent visit, were clerks and receptionists at Williamson Gynecology’s office as helpful as you thought they should be? Yes, definitely Yes, somewhat No Question Title * 23. During your most recent visit, did clerks and receptionists at Williamson Gynecology’s office treat you with courtesy and respect? Yes, definitely Yes, somewhat No Question Title * 24. In general, how would you rate your overall health? Excellent Very good Good Fair Poor Question Title * 25. In general, how would you rate your overall mental or emotional health? Excellent Very good Good Fair Poor Question Title * 26. What is your age? 18 to 24 25 to 34 35 to 44 45 to 54 55 to 64 65 to 74 75 or older Question Title * 27. What is your race? Mark one or more. White Hispanic or Latino Black or African American Asian Native Hawaiian or Other Pacific Islander American Indian or Alaska Native Other Question Title * 28. Did someone help you complete this survey? Yes No Question Title * 29. How did that person help you? Mark one or more. Read the questions to me Wrote down the answers I gave Answered the questions for me Translated the questions into my language Helped in some other way Question Title * 30. This survey is anonymous. If you would like a return call concerning your appointment, please enter your name and contact information and someone will contact you. Done
