Your comments and suggestions are very important to us as we strive to provide the best possible care to our patients. We take your comments seriously as they are extremely helpful for improving the quality of care provided to our patients.

It is not necessary to provide your name. You may send a copy of your comments to any of our clinic locations, or you may scan and email a confidential copy directly to 24hourabortion@gmail.com.

This comment area is meant to determine only about your satisfaction with your visit to our office.  If you are having a medical question or problem after the visit, please call the office where you received your services.

Date of Visit: Month___________________________ Day__________________________ Year____________

Which Office did you visit?

_____Orlando Women’s Center

_____The EPOC Clinic

_____Women’s Center of Hyde Park

_____Ft. Lauderdale Women’s Center

_____Ocala Women’s Center

On a scale of 1 to 10 (1 being the lowest and 10 being the highest) how would you rate the following:

_____How you were treated on the telephone when calling to schedule an appointment

_____Front Office Staff

_____Appearance of the office

_____Physican

_____Medical Staff

_____Recovery Team

Were you given information about the following: Yes or No

_____Emergency Contraception

_____Advanced IV Sedation

_____Same Day Abortion By PiIl

_____Funding or Cost Saving Coupon

Is there anything we could have done to make your visit more comfortable?

__________________________________________________________________________________________

__________________________________________________________________________________________

__________________________________________________________________________________________

Did any staff member go out of their way to enhance your visit in any manner?

__________________________________________________________________________________________

__________________________________________________________________________________________

__________________________________________________________________________________________

Please note any additional comments you would like to share.

__________________________________________________________________________________________

__________________________________________________________________________________________

__________________________________________________________________________________________

Thank you for taking the time to complete this questionnaire.