WHCMA Patient Survey

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Patient Survey

How are we doing?

WHCMA Patient Satisfaction Survey
At WHCMA, our goal is to provide comfort, convenience and satisfaction, as well as the best medical care to all our patients. We would like to know how you feel about our medical services, our patient-handling systems and our physicians and staff members.

Would you please take a few minutes of your time to complete this survey?

Your comments will help us evaluate our operations to ensure that we are truly responsive to your needs. Thank you!

Which facility was your appointment at?
 
Worcester
Marlboro
Webster
 
Was this appointment for:
 
OB Care
Gynecology Care
Annual Exam
Surgery
Post Partum Care
Digital Mammography
Ultrasound
Other
 
Was this appointment with:
 
Dr. Peter Davidow
Dr. Dina Deldon-Saltin
Dr. Jaimee DeMone
Dr. Abraham Fischer
Dr. Meredith Kern
Dr. Elizabeth Kopin
Dr. June O’Connor-Ramsaran
Dr. Kerri Osterhaus-Houle
Dr. Diane Pingeton
Dr. Stanley Surette
Dr. Tiffany Forti
Dr. Diego Illanes
 

Please select the most appropriate response for the following questions:
5-excellent 4-very good 3-good 2-fair 1-poor NA-not applicable

How satisfied were you with the…

Receptionist?
 5  4  3  2  1  NA
 
Nursing Staff?
 5  4  3  2  1  NA
 
Doctor?
 5  4  3  2  1  NA
 

Please select the most appropriate response for the following questions:
5-excellent 4-very good 3-good 2-fair 1-poor NA-not applicable

How would you rate your appointments with us?

Available within a reasonable amount of time?
 5  4  3  2  1  NA
 
Scheduled at a convenient time of day?
 5  4  3  2  1  NA
 
Completed in a timely manner?
 5  4  3  2  1  NA
 
Availability with provider desired?
 5  4  3  2  1  NA
 
During your appointment with our provider did you feel the provider listened to you?
 5  4  3  2  1  NA
 
Did the provider answered your questions?
 5  4  3  2  1  NA
 
Was the examination thorough?
 5  4  3  2  1  NA
 
Was the amount of time spent with you appropriate?
 5  4  3  2  1  NA
 
How did you hear about us?
 Family Member
 Friend
 Coworker
 TV
 Yellow Pages
 Website
 Search Engine
 Print Ad
 Health Fair
 

Please select the most appropriate response for the following questions:
5-excellent 4-very good 3-good 2-fair 1-poor NA-not applicable

How would you rate our facility?

Hours are convenient?
 5  4  3  2  1  NA
 
Overall comfort of office?
 5  4  3  2  1  NA
 

Would you recommend our office to a friend?

 Yes

 NoIf not, please tell us what would make you willing to recommend us?

Would you like to be contacted?

 Yes

 No

Name and Contact Information: