Patient Satisfaction Survey

Your comments will help improve the healthcare we provide.

Your Opinion Counts!

Our Practice Mission Statement declares, “SGFC is committed to providing the most comprehensive, efficient, fiscally responsible, and compassionate care possible, involving both the medical and emotional aspects of infertility.”

To help us evaluate how we are doing, please take a moment to fill out this brief patient satisfaction survey. Your comments, both positive and negative, provide important feedback and insight and help us improve on the services we provide for patients in the future.


Patient Information

Name (Optional) :        

Physician (Optional) :   

Nurse(s) (Optional) :    

Procedure(s) :              IUI    IVF    ICSI    FET   

                                   Donor Egg    Surgery   

                                   Other   


Primary Location :       


Reception

   
Excellent
Good
Fair
Poor
N/A
1. Were your phone calls handled in a prompt and courteous manner?
2. Were you able to make an appointment without difficulty?
3. Were you greeted in a friendly manner when you arrived for your appointment?
4. Was our waiting room comfortable?
5. Did we prepare you for what to expect at your appointment?
 
   
15
20
30
45
60+
6. How long was your average waiting time in minutes?

Comments :




Physicians

   
Excellent
Good
Fair
Poor
N/A
1. Was your physician clinically experienced and knowledgeable?
2. Were you given a complete assessment of your of your situation and treatment options?
3. Did you feel that you had enough contact with your physician at the time of your initial visit?
4. Did you feel that you had enough contact with your physician during follow-up?
5. Were you shown courtesy and attention?



Nurses

   
Excellent
Good
Fair
Poor
N/A
1. Were you shown courtesy and attention?
2. Were your questions handled to your satisfaction?
3. Were your phone calls returned within an appropriate time frame?
4. Were you given a clear understanding of what to expect during treatment?
5. Were the nurses skillful and knowledgeable?

Comments :




Surgical Procedure (and Embryo Transfer)

   
Excellent
Good
Fair
Poor
N/A
1. Were you shown courtesy and attention by the Procedure area staff?
2. Was your interaction with the anesthesia staff satisfactory?
3. Were you comfortable in the Procedure area?
4. Were you satisfied with the follow up after your procedure?

Comments :




Business Office

   
Excellent
Good
Fair
Poor
N/A
1. Were your financial counselors helpful in assisting with insurance benefit inquiries?
2. Were you aware of our business policies before a procedure was initiated?
3. Did we respond to your questions and concerns in a timely manner?
4. Were you shown courtesy and attention?

Comments :




Written / Visual / Website

   
Excellent
Good
Fair
Poor
N/A
1. Were the treatment books helpful?
2. Did you refer to written information provided to you during your cycle?
3. Did you receive handouts to explain each step of the process?
4. Did you find the information on the website helpful?

Comments :




Additional Services

   
Excellent
Good
Fair
Poor
N/A
1. If you have used our Social Work / Counseling Services / Support Groups, have you found them :
2. If you have used our complementary medicine groups (yoga / nutrition / smoking cessation / massage / exercise / Mind-Body), have you found them :
3. If you have used our Andrology Services (for semen analyses, sperm freezes, IUI samples), have you found them :
4. If you have had weekend services, have you found them :

5. If you have used weekend services, are there any comments / suggestions you have?




Overall

   
Excellent
Good
Fair
Poor
N/A
1. Please rate your overall experience in our Practice.
2. Would you recommend this Practice to others?
Yes
No



Comments

Can We Improve Our Service?

Please tell us what or who had a positive impact on your treatment; and/or please suggest one area of improvement that would have made a significant difference in your overall experience :





Thank you for your participation in the Shady Grove Patient Satisfaction Survey.

If you would like to discuss your care in more detail, please contact Kathy Bugge at 301-545-1222.