Women's Health Alliance

Survey

Please rate your most recent experience with Women’s Health Alliance. Your comments and suggestions are every important to us and will be taken into consideration as we continue to strive to provide the ever best in customer service and clinical care.

-	Please rate the ease in scheduling an appointment	Not Applicable Excellent Above Average Average Below Average Poor
-	Please rate the overall experience in checking in for your appointment	Not Applicable Excellent Above Average Average Below Average Poor
-	Please rate the overall experience in checking out after your appointment	Not Applicable Excellent Above Average Average Below Average Poor
-	If applicable, please rate our assistance with pre-visit insurance questions or concerns	Not Applicable Excellent Above Average Average Below Average Poor
-	Please rate the professionalism of our medical technicians who assisted your from the waiting room to the exam room	Not Applicable Excellent Above Average Average Below Average Poor
-	Please rate our care for your privacy and confidentially	Not Applicable Excellent Above Average Average Below Average Poor
-	How long did you wait in the waiting room before Being taken back to an exam room?	Not Applicable 1-10 minutes 10-15 minutes 15-20 minutes 20-30 minutes More than 30 minutes
-	Please rate the cleanliness of our facility	Not Applicable Excellent Above Average Average Below Average Poor
-	Please rate the care, compassion and professionalism of your doctor.	Not Applicable Excellent Above Average Average Below Average Poor
-	How long did you wait in the exam room before being seen by a physician	Not Applicable 1-10 minutes 10-15 minutes 15-20 minutes 20-30 minutes More than 30 minutes
-	If applicable, please rate your experience with our Triage nurses	Not Applicable Excellent Above Average Average Below Average Poor
-	If applicable, please rate the timeliness of a response to your triage voice mail	Not Applicable Excellent Above Average Average Below Average Poor
-	If applicable, please rate your experience with our surgery scheduler	Not Applicable Excellent Above Average Average Below Average Poor
-	If applicable, please rate your experience with our medical assistants	Not Applicable Excellent Above Average Average Below Average Poor
-	If applicable, please rate the coordination of visits with Coest Labs and Women's Health Alliance.	Not Applicable Excellent Above Average Average Below Average Poor
-	If applicable, pleases rate your overall experience at Coest Lab	Not Applicable Excellent Above Average Average Below Average Poor
-	If applicable, please rate your experience with our business office	Not Applicable Excellent Above Average Average Below Average Poor
-	How likely are you to refer us to a friend?	Yes, without reservation Yes, with reservation No Not applicable

Please feel free to leave a comment if anyone in our practice was exceptional In your care and most recent visit.
Please feel free to leave any comment that would improve our practice And care to you.
If you would like to speak to someone please complete the information below And our practice manager will contact you.

Name:
Telephone:

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