Womens Care of Wisconsin

Surveys

Patient Satisfaction Survey

Our vision at Women's Care of Wisconsin is to be regarded as the most advanced facility for women’s health care by our patients. To accomplish this we need to know what we are doing right and what needs improvement.

Please take a moment to complete this patient satisfaction survey. Your response is confidential.


First Name:
Last Name:
Address:
City:
State/Province:
Zip Code:
Phone Number:
Was this your first visit at Women's Care of Wisconsin?:
Yes
No
How did you hear about Women's Care of Wisconsin?:
At which Women's Care of Wisconsin location were you seen?:
Appleton
Neenah
Oshkosh
Waupaca
Ease of getting through to the clinic on the phone:
Very Poor
Poor
Fair
Good
Very Good
Convenience of our office hours:
Very Poor
Poor
Fair
Good
Very Good
Ease of scheduling your appointment:
Very Poor
Poor
Fair
Good
Very Good
Courtesy of the staff on the phone:
Very Poor
Poor
Fair
Good
Very Good
Courtesy of staff in the registration area:
Very Poor
Poor
Fair
Good
​Very Good
Efficiency of the check-in process:
Very Poor
Poor
Fair
Good
​Very Good
Degree to which you were informed about any delays:
Very Poor
Poor
Fair
Good
Very Good
Does Not Apply
Wait time in the reception area:
Very Poor
Poor
Fair
Good
​Very Good
Friendliness of the medical assistants rooming you before seeing your provider:
Very Poor
Poor
Fair
Good
​Very Good
Concern the medical assistant showed for any discussed issues:
Very Poor
Poor
Fair
Good
​Very Good
Friendliness of the care provider (doctor, nurse practitioner, or midwife):
Very Poor
Poor
Fair
Good
​Very Good
Explanations the care provider gave you about your discussed issues:
Very Poor
Poor
Fair
Good
​Very Good
Concern the care provider showed for your questions or worries:
Very Poor
Poor
Fair
Good
​Very Good
Care provider's efforts to include you in decisions about your treatment:
Very Poor
Poor
Fair
Good
​Very Good
Information the care provider gave you about medications:
Very Poor
Poor
Fair
Good
​Very Good
Does Not Apply
Instructions the care provider gave you about follow-up care:
Very Poor
Poor
Fair
Good
​Very Good
Does Not Apply
Degree to which the care provider communicated with you in a manner you understood:
Very Poor
Poor
Fair
Good
Very Good
Amount of time the care provider spent with you:
Very Poor
Poor
Fair
Good
​Very Good
Your confidence in this care provider:
Very Poor
Poor
Fair
Good
​Very Good
Likelihood of you recommending this care provider to others:
Very Poor
Poor
Fair
Good
​Very Good
Ease of getting through to the back-office departments (for example: billing department, insurance department, etc.):
Very Poor
Poor
Fair
Good
Very Good
Does Not Apply
Courtesy of the staff within the back-office departments (for example: billing department, insurance department, etc.):
Very Poor
Poor
Fair
Good
Very Good
Does Not Apply
Helpfulness of the staff in the back-office with your concerns or questions:
Very Poor
Poor
Fair
Good
Very Good
Does Not Apply
Our overall sensitivity to your needs:
Very Poor
Poor
Fair
Good
​Very Good
Our overall concern for your privacy:
Very Poor
Poor
Fair
Good
​Very Good
The overall cleanliness of Women's Care of Wisconsin:
Very Poor
Poor
Fair
Good
​Very Good
How well the staff worked together to care for you:
Very Poor
Poor
Fair
Good
​Very Good
Would you recommend Women's Care of Wisconsin to a friend or family member?:
Yes
No
Thank you for taking our patient satisfaction survey! This space is provided for you to comment on good or bad things that may have happened during your visit. Feel free to express your opinions.:
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Women's Health Centers in the Appleton WI Area

At Women's Care of Wisconsin, we are devoted to you and your health. That means having the most advanced techniques, up-to-date educational information and a compassionate, caring staff.

Women's Care serves the Fox Valley area, cities include: Neenah, Appleton, Oshkosh and Waupaca. Our providers offer a well rounded approach to your OB/GYN care, one that meets both your physical and emotional needs throughout every phase of your life. We call it our Circle of Care.

From adolescence through menopause and beyond, you can depend on us.

It's all about you!

© 2015 Obstetrics and Gynecology, Appleton WI & Fox Valley | Women's Care of Wisconsin
920.729.7105 | 877.729.7105 - Privacy Policy

Women's Care of Wisconsin - Neenah, Appleton, Oshkosh, Waupaca WI Locations PT Center for Women, Appleton WI -3913 W Prospect Ave, Suite LL2, Appleton WI 54914 Perinatal Consulting Group - 3913 W Prospect Ave, Suite 102, Appleton WI 54914

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