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Patient Satisfaction Survey - Sher Institutes for Reproductive Medicine

Page One

Your Name (optional)

1. Please rate your doctor's level of expertise and knowledge.

2. Please rate your doctor's responsiveness to your needs/questions/concerns during your treatment.

Please enter any additional comments about your doctor here.

3. Please rate the nurses' responsiveness to your needs/questions/concerns during your treatment.

Please enter any additional comments about the SIRM nursing staff here.

4. Please indicate how well costs, payment policies, insurance coverage and other financial issues were addressed by the Sher Institute staff.

5. Please rate the overall helpfulness and competence of the front desk staff at Sher Institute.

Please enter any comments about the SIRM administrative staff here.

6. Please rate the overall level of care you received at Sher Institute.

7. Please rate your average waiting time to see your doctor during treatment.

Shorter Than Expected	About as Long as Expected	Longer Than Expected	Not Applicable

If you answered "Other" in the above question, please briefly describe in the box below how you found Sher Institute.

9. Which factor(s) helped you choose Sher Institute for your treatment? (please check all that apply)

If you checked "Other" above, please explain:

10. Would you recommend Sher Institute to others?

If you answered "no" above, please explain:

11. Please provide any comments or suggestions you have that would make your experience at Sher Institute better.

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