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Patient Satisfaction Survey

Your opinion matters to us. It is our goal to ensure that each of our patients' experience at Lifestages-Samaritan Centers For Women is positive and yes, outstanding. Please take a few moments to answer these questions regarding your visit. Your comments will help us evaluate our operations to make sure that we are truly responsive to your needs. Thank you for your help.

Sincerely,
Dr. Lloyd William Rettig, III
President & CEO, Lifestages-Samaritan Centers For Women

Your Appointment Select Best Answer
Ease of making appointments by phone:
  
Please make a selection.
Efficiency of the check-in process:
  
Please make a selection.
Appropriate waiting time (reception area, exam room):  
Please make a selection.
Comments about your appointment:
Our Staff  
Friendliness and courtesy of staff upon check-in:
  
Please make a selection.
Caring concern of our nurses/medical assistants:
  
Please make a selection.
Helpfulness of the people who assisted you with
billing and/or insurance:
  
Please make a selection.
Comments about our staff:
Your Visit With Your Provider:
(Physician, Midwife, Nurse Practitioner)
Willingness to listen carefully to you:
  
Please make a selection.
Taking time to answer your questions thoroughly
and in a way you understood:
  
Please make a selection.
Did you feel your health issues were addressed?:
  
Please make a selection.
Would you recommend this provider to others?
  
Please make a selection.
Comments about your provider:
If there is any way for us to improve our services,
please tell us about it:
Patient Name (optional):
Provider Name:
Please enter the provider name.
Date of Visit:
Please enter the date of your visit.

 


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