Valley Center for Women's Health

Ramsey: 201-236-2100
Ridgewood: 201-444-4040

Our Office

Patient Satisfaction Survey

Please take a few minutes to fill out this survey on the timeliness and the quality of the service(s) you received. We at Valley Center for Women's Health welcome your feedback and all your answers will be kept confidential. Thank you for your participation.

Patient Satisfaction Survey - Download a copy of the survey or complete the form below.


1. How did you hear about Valley Center for Women's Health? Friend
Relative
Insurance Directory
Another Physician (Please Specify)
Internet Search
Other (Please Specify)
   

2. The primary office location for your visits?

5 = Strongly Agree | 4 = Agree | 3 = Partly Agreee/Disagree
2 = Disagree | 1 = Strongly Disagree | N/A = Does Not Apply


3. Please rate your experience with the front desk.
  Your calls are answered in a courteous and helpful manner. 5 4 3 2 1 N/A
  Once your call is answered, your request is handled professionally. 5 4 3 2 1 N/A
  The receptionist who greets you is friendly and helpful. 5 4 3 2 1 N/A
  You are kept informed of delays. 5 4 3 2 1 N/A
  Additional Comments:

5 = Strongly Agree | 4 = Agree | 3 = Partly Agreee/Disagree
2 = Disagree | 1 = Strongly Disagree | N/A = Does Not Apply


4. Please rate your experience with the medical staff.
  The medical assistant that escorts you to the room is courteous and helpful. 5 4 3 2 1 N/A
  The amount of time you wait in the room is reasonable. 5 4 3 2 1 N/A
  The medical assistants answer your questions and concerns in an understandable and clear manner. 5 4 3 2 1 N/A
  The medical assistants treated you in a caring and respectful manner. 5 4 3 2 1 N/A
  Additional Comments:

5 = Strongly Agree | 4 = Agree | 3 = Partly Agreee/Disagree
2 = Disagree | 1 = Strongly Disagree | N/A = Does Not Apply


5. Please comment on the office you primarily go to.
  The waiting room is clean and comfortable. 5 4 3 2 1 N/A
  The exam room is clean and comfortable. 5 4 3 2 1 N/A
  The bathroom is clean. 5 4 3 2 1 N/A
  The office hours are convenient. 5 4 3 2 1 N/A
  Additional Comments:

5 = Strongly Agree | 4 = Agree | 3 = Partly Agreee/Disagree
2 = Disagree | 1 = Strongly Disagree | N/A = Does Not Apply


6. Please select your provider and rate your experience.
  You are satisfied with the quality of care you receive. 5 4 3 2 1 N/A
  The provider answers your questions and concerns in an understandable and clear manner. 5 4 3 2 1 N/A
  The provider treats you in a caring and respectful manner. 5 4 3 2 1 N/A
  The provider sees you close to your scheduled appointment time. 5 4 3 2 1 N/A
  The provider spends an appropriate amount of time with you. 5 4 3 2 1 N/A
  Additional Comments:

7. Overall, are you satisfied with our service and would recommend Valley Center for Women's Health?
  The medical assistant that escorts you to the room is courteous and helpful. Yes No

8. What changes would you like to see us make to improve our service to you?

9. We welcome your comments on specific employees / physicians who have been especially helpful. We also appreciate your comments on employees / physicians that did not address your needs.

 

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Thank you for taking the time to fill out our survey. We rely on our patient's feedback to help us improve our services to you. Your input is greatly appreciated.

 

Your Visit