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  • 1. Your Name

  • 2. Which of the following describes you?

  • 3. Current IVF Clinic

  • 4. What was the purpose of your most recent clinic visit?

  • 5. Please rate your experience getting your appointment scheduled.

  • 6. Upon arrival at the registration desk, were you greeted respectfully?

    • Please explain.

  • 7. Were you seen at the scheduled time?

    • How long did you wait beyond your scheduled time?

  • 8. If you waited more than 15 minutes, did a staff member offer an explanation or apology?

  • 9. Did your physician explain your options satisfactorily?

    • Please explain.

  • 10. Did your physician explain any future procedures to you fully?