| Thank you for choosing Heartland Women's Healthcare for your OB/GYN needs. Your opinion is very important to us. In order to serve you better, we have established an online customer feedback section. Please take a moment to complete the following questions so we may better serve you. You will remain anonymous, but can leave your name if you wish. |
Please indicate which provider you saw during your visit.
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How would you rate the length of time it took to get an appointment in our practice?
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Which location was your office visit at?
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Please rate the friendliness of the reception staff?
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How long did you wait in our reception area before seeing a medical assistant?
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Please rate the friendliness and professionalism of the clinical staff?
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Please rate the friendliness and professionalism of the provider(s)?
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How long did you wait in the exam room before being seen by a provider?
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How would you rate the amount of time the provider spent with you?
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Do you feel the provider did enough to assess your problem?
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Overall, how would you rate your visit?
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Would you recommend our practice to your friends and family?
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Is there anyone in our practice that you would like to give a special thanks?
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Are there any suggestions you would make to help us improve our practice?
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| Enter name (Optional) |
Visit for: (Check the closest match)
OB GYN Labs Procedure Ultrasound Multiple Reasons Other
Brief Description |
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Enter date of visit |