1: The Facililty Question 1a: How would you rate the appearance of the office?:

2: Scheduling Your Appointment Question 2a: Did you schedule an appointment by phone or e-mail?:

Question 2b: If you scheduled an appointment, did you have to wait longer than expected to get scheduled?:

Question 2c: How would you rate the ease of making an appointment by telephone?:

Question 2d: How many minutes did you wait to speak to a scheduling staff member?:

Question 2e: How would you describe the person who scheduled your appointment?:

Question 2f: Did you have any troubles completing the new patient forms?:

3: Day of Your Appointment Question 3a: How would you describe the staff at the reception desk?:

Question 3b: How many minutes did you wait beyond your scheduled appointment time?:

Question 3c: Which department(s) did you visit during your initial appointment?:

4: The Nursing Staff Question 4a: How would you rate the competence of the nurse who helped you?:

Question 4b: How would characterize the concern that the nurse showed for your problem?:

Question 4c: Did you feel your questions were answered during your clinic visit?:

5: The Doctor Question 5a: Were you able to see the practitioner of your choice?:

Question 5b: Did you feel that your practitioner spent an adequate amount of time with you?:

Question 5c: How would you characterize the demeanor of your practitioner?:

Question 5d: How would you rate the competence of your practitioner?:

Question 5e: Please rate the clarity of the practitioners explanation of your condition and treatment options?:

Question 5f: How well did your practitioner include you in healthcare decisions?:

Question 5g: Were your questions answered to your satisfaction?:

Question 5h: Would you recommend this facility and its staff to your family and friends?:

6: The Lab Staff Question 6a: How would you rate the professionalism and competence of the person who assisted you with your laboratory services?:

Question 6b: If you received a lab service, please indicate the type(s) of lab service you received:

Question 6c: How would you rate the overall service you received from the lab staff?:

7: The Financial Staff Question 7a: Do you feel you were appropriately and thoroughly counseled on your financial options?:

8: Personal Information This section is not required; however, if you would like to leave your name and contact information please complete the following:

Full name:

Email address:

Phone number:

Address:

Gender:

Age:

Please list any areas in which our service could be improved, or any additional comments you may have:

Would you like someone to contact you regarding your responses on this survey? (If "yes," please fill out a way to contact you above):

Security question: In what city is Albany IVF located?

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