Patient Survey Question Title * 1. How long have you been a patient at The Ripa Center? 1 year or less 2-4 years 5-7 years 8-10 years Question Title * 2. How would you rate the customer service provided by the staff? Excellent Good Fair Poor If you answered fair or poor, please explain: Question Title * 3. How would you rate your experience when calling The Ripa Center? Excellent Good Fair Poor If you answered fair or poor, please explain: Question Title * 4. How often are you able to schedule an appointment within your preferred time frame? Always Often Sometimes Not often If you answered sometimes or never, please explain: Question Title * 5. Which provider(s) do you typically see at The Ripa Center? Isadore Ances Evren Burakgazi-Dalkilic Consuelo Cagande Divya Chillapalli Barbara Evangelisti Cynthia Griech-McCleery Barbara Harry Kathleen Heintz Guy Hewlett Donna Hogue Ruksana Iftekhar Tara Lautenslager Rosemarie Leuzzi Martha Matthews Catharine Mayer Farah Morgan Ly Ngo Robin Perry Beth Ann Quattrocchi Saadia Rehman Dina Goldstein Silverman Yon Sook Kim Question Title * 6. How would you rate the medical care you receive as a patient at The Ripa Center? Excellent Good Fair Poor If you answered fair or poor, please explain: Question Title * 7. Have you ever attended a class at The Ripa Center? Yes No If yes, which class did you attend and did you find it to be helpful?If no, please explain: Question Title * 8. Please rate the following program options from 1-6, with 1 being of most interest to you. 1 2 3 4 5 6 Holistic Medicine (acupuncture, aromatherapy, biofeedback, homeopathy, etc) 1 2 3 4 5 6 Menopause Management 1 2 3 4 5 6 Counseling Services (stress, anxiety, relationships, depression, etc) 1 2 3 4 5 6 Osteoporosis 1 2 3 4 5 6 Facial Rejuvenation (non-surgical and surgical) 1 2 3 4 5 6 Weight Management Question Title * 9. How likely are you to refer a family member or friend to The Ripa Center? Very likely Likely Somewhat likely Not likely If you answered somewhat likely or not likely, please explain: Question Title * 10. Do you have any additional comments? Question Title * 11. If you would like to be entered to win a $100 Visa gift card as a thank you for participating in this survey, please provide your name and contact information. Name Phone # Email Address Done
