1) What phrase most accurately describes you?

I value a high level of personalized care and attention.   I value or trust the opinion of my infertility care physician.   I must have a high level of confidence in the safety of the procedure.  I must have a high level of confidence in the success of the procedure.  I must have the best physician/surgeon.   I must have the best value.

2) How did you find out about RCC? (Please check all that apply)

Board Certified Infertility (Reproductive Endocrinology) physicians Location  Participating provider (insurance)   Pregnancy rates Referring friend      Desire to see specific physician    Other (please list below)

If you selected "Other" please specify:

4) I was satisfied with the level of involvement of the Physicians.

Strongly Agree   Agree   Neutral   Disagree (describe why below)   Don't know/Can't say   If you selected "Disagree", please let us know why:

5) I was satisfied with the level of involvement and care from the
primary Physician that I initially consulted with.

Strongly Agree   Agree   Neutral   Disagree (describe why below)   Don't know/Can't say

If you selected "Disagree", please let us know why:

6) I initially consulted with.

James S. Heiner, MD   Keith L. Blauer, MD   Don't know

7) I was satisfied with the explanations I received regarding my testing and treatments.

Strongly Agree   Agree   Neutral   Disagree (describe why below)   Don't know/Can't say

If you selected "Disagree", please let us know why:

8) While researching infertility treatment options did you visit www.fertilitydr.com?

Yes   No

Strongly Agree   Agree   Neutral   Disagree (describe why below)   Don't know/Can't say

If you selected "Disagree", please let us know why:

10) I was satisfied with the professionalism and expertise of the RCC nurses and technicians.

Strongly Agree   Agree   Neutral   Disagree (describe why below)   Don't know/Can't say

If you selected "Disagree", please let us know why:

11) I am satisfied with the process of my IVF treatment cycle.

Yes   No (describe why in Q11 below)   Don't Know - need an enhancement

If you selected "Disagree", please let us know why:

12) The price I paid for IVF was in line with the value and benefits I received.

Strongly Agree   Agree   Neutral   Disagree (describe why below)   Don't know/Can't say

If you selected "Disagree", please let us know why:

13) Did you conceive; have a positive pregnancy test?

Yes   No   Results pending

14) Overall, I was satisfied with my experience at RCC.

Much better A little better Similar  Not as good  Much worse Not applicable

If you selected "Disagree", please let us know why:

16) How could we have improved your experience at RCC?

17) If you have the opportunity, will you recommended RCC to your family, friends or coworkers?

Yes   No (please describe why in the box below)

If you selected "No", please let us know why:

18) Would you be willing to serve as an RCC IVF alumni contact for other patients?
Note: If you wish to serve as an Alumni Contact, RCC will contact you in the near future with more details.

Yes (please leave your name & contact details)   No

19) Would you like RCC to contact you regarding your survey responses?
A RCC employee will contact you based on this direct request.

Yes (please leave your name & contact details)   No

Your Contact Details

20) Contact details for those wishing to be contacted.

Name:
Phone:	Format: 999-999-9999
Best time to call:
E-mail:

Thank you for your time! We value you and your opinions and appreciate
your feedback. We will sincerely evaluate all of your comments with a desire
toward improving services to all of our patients.