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We appreciate your feedback and would like to hear from you. Please complete the following Appointment Satisfaction Survey. If you had genetic counseling or further testing please wait until you receive your summary letter or results before completing the survey.

For each of the following aspects of your appointment,
please select a number from 1-10 which most appropriately represents your satisfaction.

1-Extremely Dissatisfied 10-Extremely Satisfied

Name:
Visit Date:
Total Appointment Satisfaction:	Not Applicable 1 2 3 4 5 6 7 8 9 10
Initial Ultrasound Wait Time:	Not Applicable 1 2 3 4 5 6 7 8 9 10
Doctor/Specialist Wait Time:	Not Applicable 1 2 3 4 5 6 7 8 9 10
Clarity of Verbal Information:	Not Applicable 1 2 3 4 5 6 7 8 9 10
Amount of Verbal Information:	Not Applicable 1 2 3 4 5 6 7 8 9 10
Clarity of Written Information:	Not Applicable 1 2 3 4 5 6 7 8 9 10
Amount of Written Information:	Not Applicable 1 2 3 4 5 6 7 8 9 10
Follow Up:	Not Applicable 1 2 3 4 5 6 7 8 9 10
Professionalism of Staff:	Not Applicable 1 2 3 4 5 6 7 8 9 10
Comments:	Please provide us with any additional comments
May We Contact You:	Yes (provide method below) No
How to Contact You:

If you would prefer to complete a paper version of this survey and mail it, please click HERE