ASTRA FERTILITY GROUP: Leading Infertility Treatments

REFERRING PHYSICIAN SURVEY FORM

Physician Name (optional):

Hospital Affiliation (optional):

1) How did you know about our clinic?

2) Does our clinic communicate well with you regarding your patient's care and progress?

Yes

If the answer is No, please comment:

3) Would you participate in CME rounds if they are organized quarterly?

Yes

4) Do you have any specific topics that you want covered in these educational rounds?

5) Do you have any suggestions or comments pertaining to your patient's care? Please elaborate.