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1700 75th Street, Downers Grove
IL 60516
Our Practice
Services
Abortion Pill
Abortion Pill by Mail
Abortion Procedure
Birth Control
Family Planning
Gynecology
Options Counseling
Pregnancy Testing
Prenatal Care
Sexually Transmitted Infection Testing
Ultrasound
Financial Info
Pay your Bill
No Cost Abortion Services
Insurances We Accept
Uninsured/Self Pay Information
Financial Help
Patient Resources
FAQ'S
Know Your Rights
Abortion in Illinois
Patient Rights And Responsibilities
Reproductive Rights
Pregnancy Calculator
Request An Appointment
Testimonials
Contact Us
Our Practice
Services
Abortion Pill
Abortion Pill by Mail
Abortion Procedure
Birth Control
Family Planning
Gynecology
Options Counseling
Prenatal Care
Pregnancy Testing
Sexually Transmitted Infection Testing
Ultrasound
Financial Info
No Cost Abortion Services
Insurances We Accept
Uninsured/Self Pay Information
Financial Help
Patient Resources
FAQ'S
Know Your Rights
Abortion in Illinois
Patient Rights And Responsibilities
Reproductive Rights
Pregnancy Calculator
Request An Appointment
Pay your Bill
Testimonials
Contact Us
Patient satisfaction survey
Home
patient resources
patient satisfaction survey
Abortion Pill
Abortion Pill by Mail
Abortion Procedure
Birth Control
Family Planning
Gynecology
Options Counseling
Pregnancy Testing
Prenatal Care
Sexually Transmitted Infection Testing
Ultrasound
1.
Were the instructions you received prior to surgery helpful?
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
2.
Were your financial responsibilities discussed and your questions answered?
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
3.
Was the waiting time prior to surgery as expected and reasonable?
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
4.
Was the facility clean and well kept?
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
5.
Was the staff courteous and friendly?
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
6.
Was your privacy respected at all times?
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
7.
Was your pain level as expected and well controlled?
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
8.
Was adequate time allowed for your recovery?
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
9.
Were your homecare instructions clear and helpful?
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
10.
Did you feel safe at the facility?
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
11.
Overall, do you feel you received quality healthcare at the facilities?
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
12.
Date of Service
13.
Comments
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14.
Date of Birth
15.
Patient Name
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