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1700 75th Street, Downers Grove
IL 60516
Our Practice
Services
pregnancy Termination
Surgical Abortion
Medication Abortion (Abortion Pill)
Telehealth Medication Abortion (Abortion Pill by Mail)
Ultrasound
Pregnancy Testing
Birth Control
Family Planning
Sexually Transmitted Infection Testing
Gynecology
Prenatal Care
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
Prenatal Care
pregnancy Termination
Surgical Abortion
Medication Abortion (Abortion Pill)
Telehealth Medication Abortion (Abortion Pill by Mail)
Ultrasound
Pregnancy Testing
Birth Control
Family Planning
Sexually Transmitted Infection Testing
Gynecology
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
Medication Abortion
Ultra sound
Birth Control
pregnancy Termination
Pregnancy Testing
Family Planning
Sexually Transmitted Infection Testing
Surgical Abortion
Telehealth Medication Abortion
Gynecology
Prenatal Care
1.
Were the instructions you received prior to surgery helpful?
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2.
Were your financial responsibilities discussed and your questions answered?
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3.
Was the waiting time prior to surgery as expected and reasonable?
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4.
Was the facility clean and well kept?
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5.
Was the staff courteous and friendly?
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6.
Was your privacy respected at all times?
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7.
Was your pain level as expected and well controlled?
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Neutral
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8.
Was adequate time allowed for your recovery?
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9.
Were your homecare instructions clear and helpful?
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Neutral
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10.
Did you feel safe at the facility?
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Neutral
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11.
Overall, do you feel you received quality healthcare at the facilities?
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12.
Date of Service
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14.
Date of Birth
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Patient Name
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