Patient Evaluation Form | Astra Fertility

1) How did you know about us?

2) If you have been with Astra for more than one month/cycle, what stage of your management are you at?

3) Did you receive enough information about your treatment?

Yes

No

4) Did you have a chance to discuss your treatment options, risks benefits and alternatives with your doctor?

Yes

No

5) Did you have a chance to discuss your treatment options, risks benefits and alternatives with your nurse?

Yes

No

6) Did you feel that your infertility diagnosis was clear and that your management plan addressed your diagnosis?

Yes

No

7) Did you find the staff at the clinic accessible (available)?

Yes

No

8) Would you recommend us to others?

Yes

No

9) Based on your experience visiting our clinic, how would you rate the following?

We will use this information to assess and improve our current practices. Your feedback is appreciated. Information submitted will be kept private and confidential. Thank you.

OPTIONAL:

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