What type of service did you receive from Allentown Women's Center? First Trimester Surgical Abortion Second Trimester Surgical Abortion Non-surgical Abortion Essure Tubal Sterilization STD Testing Pap Smear *
Date of Service ... *
How do you think we are doing? Very Good Average Needs Improvement NA
Ability to get in for an appointment at this facility? Very Good Average Needs Improvement NA
How was the patient representative who made your appointment? Very Good Average Needs Improvement NA
The responsiveness and politeness show by our front desk? Very Good Average Needs Improvement NA
The amount of time our treatment coordinator spent with you? Very Good Average Needs Improvement NA
The professionalism of our treatment coordinator? Very Good Average Needs Improvement NA
Did the clinician answer your questions? Very Good Average Needs Improvement NA
Was the exam room and/or surgical suites neat and clean? Very Good Average Needs Improvement NA
Did the nurse listen to your requests? Very Good Average Needs Improvement NA
The overall care provided to you? Very Good Average Needs Improvement NA
Keeping my personal information private? Very Good Average Needs Improvement NA
Courtesy Very Important Indifferent Not Important
Price Very Important Indifferent Not Important
Would you recommend Allentown Women's Center to a friend and/or relative? Yes No *
What did you like best about our facility?
What did you like least about our facility?
Would you like a manager to contact you to discuss any concerns or questions? Yes No
First & Last Name (must be provided to validate the legitamcy of this feedback form - Strictly Confidential) *
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