How satisfied are you with:

1.  Your communication with our:
A.  Front desk receptionist Very Satisfied Somewhat Satisfied Somewhat Dissatisfied Very Dissatisfied Not Applicable
B.  Telephone receptionist Very Satisfied Somewhat Satisfied Somewhat Dissatisfied Very Dissatisfied Not Applicable
C.  Billing department staff Very Satisfied Somewhat Satisfied Somewhat Dissatisfied Very Dissatisfied Not Applicable
D.  Nurses Very Satisfied Somewhat Satisfied Somewhat Dissatisfied Very Dissatisfied Not Applicable
E.  Nursing Assistants Very Satisfied Somewhat Satisfied Somewhat Dissatisfied Very Dissatisfied Not Applicable
Your Comments:
2. The efficiency of our:
A.  Front desk receptionist Very Satisfied Somewhat Satisfied Somewhat Dissatisfied Very Dissatisfied Not Applicable
B.  Telephone receptionist Very Satisfied Somewhat Satisfied Somewhat Dissatisfied Very Dissatisfied Not Applicable
C.  Billing department staff Very Satisfied Somewhat Satisfied Somewhat Dissatisfied Very Dissatisfied Not Applicable
D.  Nurses Very Satisfied Somewhat Satisfied Somewhat Dissatisfied Very Dissatisfied Not Applicable
E.  Nursing Assistants Very Satisfied Somewhat Satisfied Somewhat Dissatisfied Very Dissatisfied Not Applicable
Your Comments:
3.  How would you rate our nurses in terms of:
A.  Responsiveness to your questions Very Satisfied Somewhat Satisfied Somewhat Dissatisfied Very Dissatisfied Not Applicable
B.  Time spent with patients Very Satisfied Somewhat Satisfied Somewhat Dissatisfied Very Dissatisfied Not Applicable
C.  Medical knowledge Very Satisfied Somewhat Satisfied Somewhat Dissatisfied Very Dissatisfied Not Applicable
Your Comments:
4.  How would you rate your appointments with us:
A.  Available within a reasonable amount of time Very Satisfied Somewhat Satisfied Somewhat Dissatisfied Very Dissatisfied Not Applicable
B.  Scheduled at a convenient time of day Very Satisfied Somewhat Satisfied Somewhat Dissatisfied Very Dissatisfied Not Applicable
C.  Completed in a timely manner Very Satisfied Somewhat Satisfied Somewhat Dissatisfied Very Dissatisfied Not Applicable
D.  Availability with provider desired Very Satisfied Somewhat Satisfied Somewhat Dissatisfied Very Dissatisfied Not Applicable
Your Comments:
5.  During your appointment with our DOCTOR do you feel::
A.  The doctor listened & your questions were answered Very Satisfied Somewhat Satisfied Somewhat Dissatisfied Very Dissatisfied Not Applicable
B.  The examination was thorough Very Satisfied Somewhat Satisfied Somewhat Dissatisfied Very Dissatisfied Not Applicable
C.  The amount of time spent with you was appropriate Very Satisfied Somewhat Satisfied Somewhat Dissatisfied Very Dissatisfied Not Applicable
Who was your appointment with?
Your Comments:
6.  During your appointment with our MIDWIFE do you feel::
A.  The midwife listened & your questions were answered Very Satisfied Somewhat Satisfied Somewhat Dissatisfied Very Dissatisfied Not Applicable
B.  The examination was thorough Very Satisfied Somewhat Satisfied Somewhat Dissatisfied Very Dissatisfied Not Applicable
C.  The amount of time spent with you was appropriate Very Satisfied Somewhat Satisfied Somewhat Dissatisfied Very Dissatisfied Not Applicable
Who was your appointment with?
Your Comments:

7.  During your appointment with our NURSE PRACTITIONER do you feel::
A.  The NP listened & your questions were answered Very Satisfied Somewhat Satisfied Somewhat Dissatisfied Very Dissatisfied Not Applicable
B.  The examination was thorough Very Satisfied Somewhat Satisfied Somewhat Dissatisfied Very Dissatisfied Not Applicable
C.  The amount of time spent with you was appropriate Very Satisfied Somewhat Satisfied Somewhat Dissatisfied Very Dissatisfied Not Applicable
Who was your appointment with?
Your Comments:
8.  Was this appointment at: Saginaw    Frankenmuth    Bay City   
8.  Was this appointment for: OB care    GYN care     Well health   
Surgery    Postpartum care   Other
9.  Please rate our communication with you in the following areas:
A.  Were you calls answered promptly Very Satisfied Somewhat Satisfied Somewhat Dissatisfied Very Dissatisfied Not Applicable
B.  Availability of medical information/advice by phone Very Satisfied Somewhat Satisfied Somewhat Dissatisfied Very Dissatisfied Not Applicable
C.  The provider returning your call in a timely manner Very Satisfied Somewhat Satisfied Somewhat Dissatisfied Very Dissatisfied Not Applicable
D.  Test results reported in a reasonable amount of time  Very Satisfied Somewhat Satisfied Somewhat Dissatisfied Very Dissatisfied Not Applicable
E.  Effectiveness of health information materials Very Satisfied Somewhat Satisfied Somewhat Dissatisfied Very Dissatisfied Not Applicable
Your Comments:
10.  How did you hear about us?: Family member    Friend     Co-worker    Yellow Pages Ad     Our website
11.  How would you rate our facility:
A.  Hours of operation were convenient Very Satisfied Somewhat Satisfied Somewhat Dissatisfied Very Dissatisfied Not Applicable
B.  Overall comfort of office Very Satisfied Somewhat Satisfied Somewhat Dissatisfied Very Dissatisfied Not Applicable
C.  Adequate parking Very Satisfied Somewhat Satisfied Somewhat Dissatisfied Very Dissatisfied Not Applicable
D.  Signage and directions easy to follow Very Satisfied Somewhat Satisfied Somewhat Dissatisfied Very Dissatisfied Not Applicable
Your Comments:
12.  Overall rating:
A.  Our practice Very Satisfied Somewhat Satisfied Somewhat Dissatisfied Very Dissatisfied Not Applicable
B.  Quality of your medical care Very Satisfied Somewhat Satisfied Somewhat Dissatisfied Very Dissatisfied Not Applicable
13.  Would you recommend our office to a friend: Yes    No 
14.  If available to you, would you consider an evening appointment from 5:00 pm - 8:00 pm or an early morning appointment prior to 8:00 am?
Yes    No 
15. Would you be interested in: Yoga classes Laser hair removal Spider vein removal Skin Care Products
Weight and diet control classes Massage therapy Patient Education Classes Other
16.  If you would like someone from our office to contact you:

Please provide your name and daytime phone number: