CNY Fertility Centers Patient Survey

Patient Survey

Sex:	Male Female
Age:
For how many months have you been a patient?	less than 6 6 - 12 12 - 24 24 - 48 more than 48
Why did you choose CNY Fertility Center? (select all that apply)	Reputation Cost Location Doctor Success Rates Other:
What can we improve upon?
What do we do right?
Please evaluate the Front Office Staff (receptionist, billing, insurance):
Compassion:	1 - poor 2 - below average 3 - average 4 - good 5 - excellent
Ability to answer your questions:	1 - poor 2 - below average 3 - average 4 - good 5 - excellent
Accuracy:	1 - poor 2 - below average 3 - average 4 - good 5 - excellent
Professionalism:	1 - poor 2 - below average 3 - average 4 - good 5 - excellent
Overall quality of care:	1 - poor 2 - below average 3 - average 4 - good 5 - excellent
Comments about our Front Office:
Please evaluate the Clinical Staff (nurses and doctor):
Compassion:	1 - poor 2 - below average 3 - average 4 - good 5 - excellent
Ability to answer your questions:	1 - poor 2 - below average 3 - average 4 - good 5 - excellent
Accuracy:	1 - poor 2 - below average 3 - average 4 - good 5 - excellent
Professionalism:	1 - poor 2 - below average 3 - average 4 - good 5 - excellent
Overall quality of care:	1 - poor 2 - below average 3 - average 4 - good 5 - excellent
Comments about our Clinical Staff:
Have you ever read our E-Newsletter?
Yes How helpful was it (1-5)? Comments (good and bad):	No Why have you not read our e-Newsletter?
Have you ever used our Website?
Yes How helpful was it (1-5)? Comments (good and bad):	No Why have you not used our Website?
Have you ever used our Circle of Hope support group?
Yes How helpful was it (1-5)? Comments (good and bad):	No Why have you not used our support group?
Have you ever visited CNY Healing Arts Center?
Yes How helpful was it (1-5)? Comments (good and bad):	No Why have you not visited CNY Healing Arts Center?
Have you ever used our CNY Healing Arts Website?
Yes How helpful was it (1-5)? Comments (good and bad):	No Why have you not used our Website?