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Surveys
2014
September
N
New Century Wellness Group
New Century Wellness Group
0%
Exit Survey
Hello:
You are invited to participate in our New Century Wellness Group survey. It will take approximately five minutes to complete the questionnaire.
Your participation in this study is completely voluntary. 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 Getrude Muthiani at (616) 653 4545 or by email at the
[email protected]
Thank you very much for your time and support. Please start with the survey now by clicking on the
Continue
button below.
First Name
:
Last Name
:
Address 1
:
Address 2
:
City
:
State
:
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
District of Columbia
Zip
:
Phone
:
When was your last visit?
--
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
--
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
--
2024
*
How was the ease of making appointments by phone
-- Select --
Very Quick
Quick
Slow
Very Slow
*
How was the courtesy of the person who took your call?
Very good
Good
Poor
Bad
During this hospital visit, how quick did the nurse or doctor attend to you?
Immediately
After a short while
After a long time
Never
How satisfied are you with the following:
Very Unsatisfied
Unsatisfied
Neutral
Satisfied
Very Satisfied
Appointment scheduling
Customer Service
Treatment
overall
*
Would you recommend this clinic to your family or friends?
Yes
No
How would you rate the Clinic in general:
Facilities
Services
Comfort
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