Women's Healthcare of Illinois Patient Experience Survey

Your feedback is important to us. As we work to improve your experience, we would appreciate it if you would take a moment to complete a brief survey. (For any items that do not apply, please skip).

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* 1. How likely is it that you would recommend our practice to a friend or family member?

NOT AT ALL LIKELY

EXTREMELY LIKELY

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* 2. Please indicate which provider(s) you saw at your visit.

Kenneth Finkelstein, DO

Kathleen Slugocki, DO

Nicole Orwar, DO

Mitchell Khan, DO

Tim Johnson, DO

Tanya West-Hutchins, MSN, FNP-BC

Beth Helme-Smith, CNM, WHNP-BC

Tiphne Sharpe, MSN, WHNP-BC

Jaclyn Serafin, APN, CNM-BC

Shawna Pape, MSN, CNM-BC

Sonographer (Ultrasound Tech)

Other

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* 3. Your Appointment. Please rate your recent appointment scheduling and visit experience.

	Poor	Fair	Good	Very Good	Excellent
Ease of appointment made by phone	Ease of appointment made by phone Poor	Ease of appointment made by phone Fair	Ease of appointment made by phone Good	Ease of appointment made by phone Very Good	Ease of appointment made by phone Excellent
Ease of appointment made online (patient portal, etc)	Ease of appointment made online (patient portal, etc) Poor	Ease of appointment made online (patient portal, etc) Fair	Ease of appointment made online (patient portal, etc) Good	Ease of appointment made online (patient portal, etc) Very Good	Ease of appointment made online (patient portal, etc) Excellent
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
Convenience of your appointment date/time	Convenience of your appointment date/time Poor	Convenience of your appointment date/time Fair	Convenience of your appointment date/time Good	Convenience of your appointment date/time Very Good	Convenience of your appointment date/time Excellent
Efficiency of the check in process	Efficiency of the check in process Poor	Efficiency of the check in process Fair	Efficiency of the check in process Good	Efficiency of the check in process Very Good	Efficiency of the check in process Excellent
Keeping you informed of delays	Keeping you informed of delays Poor	Keeping you informed of delays Fair	Keeping you informed of delays Good	Keeping you informed of delays Very Good	Keeping you informed of delays Excellent

Any advice or comments on your appointment scheduling experience (optional)

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* 4. Your Appointment. Please indicate the how much time you spent waiting to see your provider.

	Less than 5 minutes	5 - 15 minutes	15 - 30 minutes	30 - 45 minutes	More than 45 minutes
Wait time in the waiting room	Wait time in the waiting room Less than 5 minutes	Wait time in the waiting room 5 - 15 minutes	Wait time in the waiting room 15 - 30 minutes	Wait time in the waiting room 30 - 45 minutes	Wait time in the waiting room More than 45 minutes
Wait time in the exam room	Wait time in the exam room Less than 5 minutes	Wait time in the exam room 5 - 15 minutes	Wait time in the exam room 15 - 30 minutes	Wait time in the exam room 30 - 45 minutes	Wait time in the exam room More than 45 minutes

Any advice or additional comments on your wait times (optional).

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* 5. Our Facility. Please indicate the office location you recently visited.

Evergreen Park

Mokena

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* 6. Our Facility. Please rate your satisfaction with our facility.

	Poor	Fair	Good	Very Good	Excellent
Convenience of facility location	Convenience of facility location Poor	Convenience of facility location Fair	Convenience of facility location Good	Convenience of facility location Very Good	Convenience of facility location Excellent
Availability of parking	Availability of parking Poor	Availability of parking Fair	Availability of parking Good	Availability of parking Very Good	Availability of parking Excellent
Cleanliness of facility	Cleanliness of facility Poor	Cleanliness of facility Fair	Cleanliness of facility Good	Cleanliness of facility Very Good	Cleanliness of facility Excellent
Cleanliness and comfort of the waiting/reception areas	Cleanliness and comfort of the waiting/reception areas Poor	Cleanliness and comfort of the waiting/reception areas Fair	Cleanliness and comfort of the waiting/reception areas Good	Cleanliness and comfort of the waiting/reception areas Very Good	Cleanliness and comfort of the waiting/reception areas Excellent
Cleanliness and comfort of the exam room	Cleanliness and comfort of the exam room Poor	Cleanliness and comfort of the exam room Fair	Cleanliness and comfort of the exam room Good	Cleanliness and comfort of the exam room Very Good	Cleanliness and comfort of the exam room Excellent

Any advice or comments on our facility (optional)

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* 7. Our Staff. Please rate your recent experience with our staff.

	Poor	Fair	Good	Very Good	Excellent
The courtesy of the person on the phone	The courtesy of the person on the phone Poor	The courtesy of the person on the phone Fair	The courtesy of the person on the phone Good	The courtesy of the person on the phone Very Good	The courtesy of the person on the phone Excellent
The friendliness and courtesy of the reception staff	The friendliness and courtesy of the reception staff Poor	The friendliness and courtesy of the reception staff Fair	The friendliness and courtesy of the reception staff Good	The friendliness and courtesy of the reception staff Very Good	The friendliness and courtesy of the reception staff Excellent
The caring concern, knowledge, and helpfulness of our medical assistants/nurses	The caring concern, knowledge, and helpfulness of our medical assistants/nurses Poor	The caring concern, knowledge, and helpfulness of our medical assistants/nurses Fair	The caring concern, knowledge, and helpfulness of our medical assistants/nurses Good	The caring concern, knowledge, and helpfulness of our medical assistants/nurses Very Good	The caring concern, knowledge, and helpfulness of our medical assistants/nurses Excellent
The professionalism of our sonographers	The professionalism of our sonographers Poor	The professionalism of our sonographers Fair	The professionalism of our sonographers Good	The professionalism of our sonographers Very Good	The professionalism of our sonographers Excellent

Any additional comments on your experience with our staff (optional).

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* 8. Our Communication. Please rate your experience with our communication.

	Poor	Fair	Good	Very Good	Excellent
Your ability to reach us during normal office hours	Your ability to reach us during normal office hours Poor	Your ability to reach us during normal office hours Fair	Your ability to reach us during normal office hours Good	Your ability to reach us during normal office hours Very Good	Your ability to reach us during normal office hours Excellent
Your phone calls were answered promptly	Your phone calls were answered promptly Poor	Your phone calls were answered promptly Fair	Your phone calls were answered promptly Good	Your phone calls were answered promptly Very Good	Your phone calls were answered promptly Excellent
Your messages were returned in a timely manner	Your messages were returned in a timely manner Poor	Your messages were returned in a timely manner Fair	Your messages were returned in a timely manner Good	Your messages were returned in a timely manner Very Good	Your messages were returned in a timely manner Excellent
Your ability to contact us after hours	Your ability to contact us after hours Poor	Your ability to contact us after hours Fair	Your ability to contact us after hours Good	Your ability to contact us after hours Very Good	Your ability to contact us after hours Excellent
Your ability to easily obtain prescription refills	Your ability to easily obtain prescription refills Poor	Your ability to easily obtain prescription refills Fair	Your ability to easily obtain prescription refills Good	Your ability to easily obtain prescription refills Very Good	Your ability to easily obtain prescription refills Excellent
Explanation of your procedures, options, or test results by our staff	Explanation of your procedures, options, or test results by our staff Poor	Explanation of your procedures, options, or test results by our staff Fair	Explanation of your procedures, options, or test results by our staff Good	Explanation of your procedures, options, or test results by our staff Very Good	Explanation of your procedures, options, or test results by our staff Excellent
Quality and effectiveness of our health information	Quality and effectiveness of our health information Poor	Quality and effectiveness of our health information Fair	Quality and effectiveness of our health information Good	Quality and effectiveness of our health information Very Good	Quality and effectiveness of our health information Excellent

Any additional comments on your experience with our communication (optional).

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* 9. Your Care Provider. Please rate your experience with your care provider.

	Poor	Fair	Good	Very Good	Excellent
Listened carefully to you	Listened carefully to you Poor	Listened carefully to you Fair	Listened carefully to you Good	Listened carefully to you Very Good	Listened carefully to you Excellent
Took time to answer your questions	Took time to answer your questions Poor	Took time to answer your questions Fair	Took time to answer your questions Good	Took time to answer your questions Very Good	Took time to answer your questions Excellent
Explained things in a way you can understand	Explained things in a way you can understand Poor	Explained things in a way you can understand Fair	Explained things in a way you can understand Good	Explained things in a way you can understand Very Good	Explained things in a way you can understand Excellent
Empowered you to make your healthcare decisions	Empowered you to make your healthcare decisions Poor	Empowered you to make your healthcare decisions Fair	Empowered you to make your healthcare decisions Good	Empowered you to make your healthcare decisions Very Good	Empowered you to make your healthcare decisions Excellent
Amount of time spent with you	Amount of time spent with you Poor	Amount of time spent with you Fair	Amount of time spent with you Good	Amount of time spent with you Very Good	Amount of time spent with you Excellent
Instructions on treatment options and follow up care	Instructions on treatment options and follow up care Poor	Instructions on treatment options and follow up care Fair	Instructions on treatment options and follow up care Good	Instructions on treatment options and follow up care Very Good	Instructions on treatment options and follow up care Excellent
Advice provided on maintenance of health and wellness	Advice provided on maintenance of health and wellness Poor	Advice provided on maintenance of health and wellness Fair	Advice provided on maintenance of health and wellness Good	Advice provided on maintenance of health and wellness Very Good	Advice provided on maintenance of health and wellness Excellent

Any additional comments on your experience with your care provider (optional).

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* 10. Your Overall Satisfaction. Please rate your overall satisfaction with:

	Poor	Fair	Good	Very Good	Excellent
Our facility	Our facility Poor	Our facility Fair	Our facility Good	Our facility Very Good	Our facility Excellent
Our staff	Our staff Poor	Our staff Fair	Our staff Good	Our staff Very Good	Our staff Excellent
Your care provider(s)	Your care provider(s) Poor	Your care provider(s) Fair	Your care provider(s) Good	Your care provider(s) Very Good	Your care provider(s) Excellent
The quality of your medical care	The quality of your medical care Poor	The quality of your medical care Fair	The quality of your medical care Good	The quality of your medical care Very Good	The quality of your medical care Excellent
Your overall experience with our practice	Your overall experience with our practice Poor	Your overall experience with our practice Fair	Your overall experience with our practice Good	Your overall experience with our practice Very Good	Your overall experience with our practice Excellent

Any additional comments on your overall experience (optional).

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* 11. Is there anything you can suggest we work on or services we can add to improve the value and quality of care you receive from our practice? (Optional)

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* 12. If you would like to be contacted regarding your experience, please enter your contact information below.

Name

Email Address

Phone Number