Thank you for choosing us as the provider for your recent assisted reproductive care. We’d appreciate any feedback you could give us to help improve our program. Please complete the survey below and be assured we value your comments and suggestions and will utilize them whenever possible. Thank you for your assistance.

1. Which procedure applies to you? Choose procedure IVF cycle Frozen embryo transfer cycle IVM cycle Other
   
Circle the appropriate ranking for each area.
2. Initial contact with physician’s office and staff:
   Excellent Good Satisfactory Poor Very Poor
3. Physician performing infertility evaluation: Choose Physician or Practitioner Johanna S Archer Henry C Bohler Christine L Cook Travis W McCoy
   Steven T Nakajima Linda Elkins Andrew Moore Rhiana Saunders Marvin Yussman
   
4. Please rank the infertility evaluation:
   Excellent Good Satisfactory Poor Very Poor
5. Communication with nursing staff:
   Excellent Good Satisfactory Poor Very Poor
6. Explanation of fees:
   Excellent Good Satisfactory Poor Very Poor
7. Explanation of how to take / use medication:
   Excellent Good Satisfactory Poor Very_Poor
8. Explanation of what to expect during the cycle:
   Excellent Good Satisfactory Poor Very_Poor
9. Endocrine Laboratory services:
   Excellent Good Satisfactory Poor Very_Poor
10. Informed Consent Forms:
    Excellent Good Satisfactory Poor Very_Poor
11. Embryology staff services:
    Excellent Good Satisfactory Poor Very_Poor
12. Communication with embryology staff :
    Excellent Good Satisfactory Poor Very_Poor
13. Communication with physician(s):
    Excellent Good Satisfactory Poor Very_Poor
14. Ultrasound services:
    Excellent Good Satisfactory Poor Very_Poor
15. Physician performing Egg retrieval: Choose Physician or Practitioner Johanna S Archer Henry C Bohler Christine L Cook Travis W McCoy
    Steven T Nakajima Linda Elkins Andrew Moore Rhiana Saunders Marvin Yussman
    
16. Physician performing embryo transfer: Choose Physician or Practitioner Johanna S Archer Henry C Bohler Christine L Cook Travis W McCoy
    Steven T Nakajima Linda Elkins Andrew Moore Rhiana Saunders Marvin Yussman
    
17. What are your impressions of the physical facilities at the Fertility Center? What suggestions for improvement would you make?
    
18. What specific suggestion would you make to improve the IVF services provided by the Fertility Center?
    
19. What suggestion do you have for improving the care provided by the Fertility Center Staff?
    
20. How did you hear about the Fertility Center at University Women’s Healthcare?
    
21. What month & year were you at the Fertility Center for treatment?
    
22. Would you refer others to University Women's HealthCare for care?
    Definitely Yes Probably Yes Probably No Definitely No
23. Please feel free to share any other comments or concerns that you have:
    

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