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Hello:
You are invited to participate in our survey for the Women's Center. In this survey, approximately 600 women will be asked to complete a survey that asks questions about their health screening practices and use of the Women's Center. It will take approximately 10 minutes to complete the questionnaire.

Your participation in this study is completely voluntary. There are no foreseeable risks associated with this project. However, if you feel uncomfortable answering any questions, you can withdraw from the survey at any point. It is very important for us to learn your opinions.

Your survey responses will be strictly confidential and data from this research will be reported only in the aggregate. Your information will be coded and will remain confidential. If you have questions at any time about the survey or the procedures, you may contact Jane Doe at 555-678-1234 or by email at the email address specified below.

Thank you very much for your time and support. Please start with the survey now by clicking on the Continue button below.
 
 
 
Are you aware of the Women's Center located at Newton Medical Center?
 
Yes
 
No
 
I have heard of it but have never been there
 
Other
 
 
 
 
If you are 40 years old or greater, do you have an annual mammogram?
 
Yes
 
No
 
I am less than 40 years old
 
Other
 
 
 
 
Which services have you received at the Women's Center in the last two years?
 
mammogram
 
ultrasound of the breast
 
obstetrical sonogram
 
steriotactic needle biopsy of the breast
 
amniocentesis
 
Other
 
 
 
If your answer to question #3 is yes, how satisfied are you with the following?:
If your answer to question #3 is no, please skip question #4
Very Unsatisfied Unsatisfied Neutral Satisfied Very Satisfied N/A
Check in process
Notification of procedure results
Technician customer service
 
 
 
If you have chosen to not have procedures completed at the Women's Center, please share with us the rationale for your choice. Some suggestions are offered as well as a space for your own answer.
 
Cost
 
Customer Service deficiencies
 
Radiologist reporting delays
 
Established elsewhere
 
Other
 
 
 
 
If supplemental funds were available (other than health insurance or self-pay) would you seek annual healthy-woman care?
 
Yes
 
No
 
Payment is not a concern
 
I need full coverage, I am unable to pay for health care
 
Other
 
 
 
 
Are there ways the Women's Center can help you meet your personal health care needs?
   
 
 
 
The Women's Center was founded on compassionate care for the women of Harvey and surrounding counties. Thank you for contributing to our effort to provide the highest quality of care that meets the needs of our patients.