Home Arlington, Virginia * Reston, Virginia * Loudoun, Virginia * Washington, DC
Tel: (703) 920-3890
Dominion Fertility

PATIENT SURVEY

We are continually striving to better meet your needs and make your satisfaction by making sure the treatment and care you receive is the best available. Please take a few minutes to complete the survey.

Thank you for your assistance.
Your Name:
Your Email Address:

Your Phone Number:
Please complete this patient survey
about Dominion Fertility where you received
medical treatment.
Poor Fair Good Very Good Excellent
1. Location of the office
2. Availability of appointments
3. Parking facilities
4. Length of time in the waiting room
5. Accessibility of the Physician(s)
6. Accessiblility of the nursing staff
7. Friendliness of phone reception
8. Length of time to return phone calls
9. Friendliness of reception during visit(s)
10. Atmosphere and décor of the office
11. Competency of staff
12. Professionalism of staff
13. Quality of Laboratory Service
14. Explanantion of financial obligations
15. Friendliness of financial advisor
16. Prices vs. value of services provided
17. Explanation of questions regarding Therapy
18. My overall experience at Dominion Fertility
19. Please select the reason for your visit today: