Azalea Gynecology - Women Caring for Women, 910-452-3666

 Additionally, we offer no interest payment plans to qualifying patients through CareCredit®.

We accept Visa.We accept Mastercard.We accept Discover/Novus.We accept CareCredit.
 
 
 
 
 
 
 
 

Patient Forms

Azalea Gynecology Office Policy
New Patient Packet – Please complete and bring with you to your appointment
New Patient History Form
Location Map

Patient Satisfaction Survey or take our Patient Satisfaction Survey online below:

 
 

Azalea Gynecology
1814 New Hanover Medical Park Drive
Wilmington, NC 28403
 
Phone: 910-452-3666
Fax: 910-397-0930
Email: admin@azaleagyn.com
 
Hours of Operation:
Monday – Friday
8 a.m. – 5 p.m.

Visit Azalea Laser and Skin Care
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Comments

1. The time between your call to schedule an appointment and your appointment date.

Did we fit you in fast enough?
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The time it took us to answer your call?
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The manners of the person(s) who scheduled your appointment?
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The convenience of our office location?
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2. The professionalism and helpfulness of your reception.

Was the receptionist polite?
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Your wait time in the office?
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The comfort, cleanliness and amenities of the reception area?
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3. Your provider:
Dr. Daily
Dr. Antonelli
Shirley Aycoth, NP-C
Melissa Smith, PA-C
The amount of time spent with your provider?
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Her listening?
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Her explanation of procedures, diagnoses, or treatment regimen?
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Her “bedside manner”?
 
 
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Prescription refills --- if appropriate?
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4. If you have visited our practice before, how convenient did you find:

Comments
5
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2
1
Getting lab results--- if appropriate?
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Overall, how would you rate our practice?
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Comments
Name:
Date:
Please contact me to discuss further:
Yes
No
Contact phone number:


 
Patient Satisfaction Survey 

We want to be sure we are doing everything we can to serve you. Please take a minute to fill out this survey.
All responses are confidential. Just let us know what to do better!
Thank you. 
 
On a scale from 1 to 5, with 5 being excellent and 1 being poor, how would you rate:

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