Online Survey

Would you be willing to take our online survey?

We want to continuously improve our site. Would you take a minute to complete our online survey below?

Please note that this survey is intended to be anonymous and shall be used for the purpose of improving our website.  We appreciate your time to complete our survey and hope you will continue to visit our site.

1.  How often do you visit this website?

	More than once per month.
	Less than once per month.
	This is my first visit

2. What do you like about this website? (select as many as you like)

	The home page layout with the navigation bar on the left.
	The easy-to-understand categories.
	The photos of the providers and staff.
	The colors of the website.
	The descriptions of the providers.
	Other:

3. How did you find this website?

	Searched for a particular provider.
	Searched for a particular clinic.
	Searched for a particular location.
	Searched for a particular health care topic. Please list below.

4. How often do you use the Internet for health care information?

	Daily
	Weekly
	Monthly
	Yearly
	Very Rarely

5. How could we improve this site? Please selet all that apply.

	More women's health information. What type?
	More links to other sites. Please tell us which sites.
	Information about insurance plans and fees.
	Ability to view my billing statement online.
	Link to pay my bill online.
	Ability to email a provider at Western Ob/Gyn.
	Less information - there is too much on this site.
	Ability to email the business office with questions.

6. Are you a patient of Western Ob/Gyn Women's Health Center?

Yes
No

7. Are you male or female?

Male
Female

8. What is your age?

0-17
18-25
26-45
46-55
56-65
>66

9. How often do you use the Internet?

Daily.
Weekly.
Monthly.
A few times a year.
Almost never.

10. Do you use the Internet for Personal use and/or Business?

Personal
Business
Both