Patient Package Survey

Dear Patient,

At the office of Dr. Bojana Jankovic Weatherly, we want to know how we can do better and continue to evolve and provide the best quality care and value to our patients. Please take a moment to fill out our winter 2020 survey. This survey is focused around package, membership and appointment structure. Please feel free to note if you’d like to be contacted regarding the survey.

First Name

Last Name

Email Address

What do you enjoy most about working with us?

What can we do to improve your experience?

Which applies to the appointment option you chose

Was price a contributing factor in choosing not to opt into a package?

Would you prefer to participate in a package or Membership?

A package is a one-time, up-front payment with set amount of visits for 12 months. A membership is lower monthly payments for 12 months with a maximum number of visits available within the year.

Up to how many visits with the doctor would you like to have available over the course of one year?

Up to how many visits with the health coach would you like to have available over the course of one year?

How important is it to you to have a health coach or registered dietician on your healthcare team?

How would you rate the effects of nutrition and lifestyle changes on your outcome. (1 Being none or not at all, and 10 being highly reliant)?

Do you prefer in-office appointments where you can meet in person with your health coach or dietitian, or would you prefer these types of consults happen by phone or video chat?

Do you currently see any additional medical or other provider, who has an out of pocket appointment structure such as a package or a membership for appointments?

Would you be interested in receiving primary care from Dr. Bojana Jankovic Weatherly in the future (in addition to integrative medicine consultations)?

Do you have additional comments or questions on this topic?

How likely are you to recommend our practice on a scale from 0 to 10 (0 being very unlikely and 10 being very likely)?

May we contact you to discuss this further?

I preferred to be contacted via

Phone Number

Wishing You a Happy and Healthy 2020!

Dr. Bojana and Bridget

Patient Package Survey

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