Medical Patient Survey

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1. Who is the doctor or nurse practitioner who usually sees your child ?

Dr Satish PrabhuDr Crystal VernonMs Pamela BushMs Susan DonLevyMs Lissa FriedmanMs Jennifer NelsonMs Janna RoperNot sure

Who is the doctor or nurse practitioner who usually sees your child ?

2. Please respond to how you agree with the following statements:

	Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree	N/A
1) My child usually gets to see the same Nurse practitioner or doctor.	*Please respond to how you agree with the following statements: 1) My child usually gets to see the same Nurse practitioner or doctor. Strongly Disagree	1) My child usually gets to see the same Nurse practitioner or doctor. Disagree	1) My child usually gets to see the same Nurse practitioner or doctor. Neutral	1) My child usually gets to see the same Nurse practitioner or doctor. Agree	1) My child usually gets to see the same Nurse practitioner or doctor. Strongly Agree	1) My child usually gets to see the same Nurse practitioner or doctor. N/A
2) When I call to make an appointment the person who answers the phone is usually helpful and courteous.	2) When I call to make an appointment the person who answers the phone is usually helpful and courteous. Strongly Disagree	2) When I call to make an appointment the person who answers the phone is usually helpful and courteous. Disagree	2) When I call to make an appointment the person who answers the phone is usually helpful and courteous. Neutral	2) When I call to make an appointment the person who answers the phone is usually helpful and courteous. Agree	2) When I call to make an appointment the person who answers the phone is usually helpful and courteous. Strongly Agree	2) When I call to make an appointment the person who answers the phone is usually helpful and courteous. N/A
3) Making appointments at RKC has been an easy process.	3) Making appointments at RKC has been an easy process. Strongly Disagree	3) Making appointments at RKC has been an easy process. Disagree	3) Making appointments at RKC has been an easy process. Neutral	3) Making appointments at RKC has been an easy process. Agree	3) Making appointments at RKC has been an easy process. Strongly Agree	3) Making appointments at RKC has been an easy process. N/A
4) Once I arrive at the clinic my check in process is efficient.	4) Once I arrive at the clinic my check in process is efficient. Strongly Disagree	4) Once I arrive at the clinic my check in process is efficient. Disagree	4) Once I arrive at the clinic my check in process is efficient. Neutral	4) Once I arrive at the clinic my check in process is efficient. Agree	4) Once I arrive at the clinic my check in process is efficient. Strongly Agree	4) Once I arrive at the clinic my check in process is efficient. N/A
5) My wait time in the waiting area is usually reasonable	5) My wait time in the waiting area is usually reasonable Strongly Disagree	5) My wait time in the waiting area is usually reasonable Disagree	5) My wait time in the waiting area is usually reasonable Neutral	5) My wait time in the waiting area is usually reasonable Agree	5) My wait time in the waiting area is usually reasonable Strongly Agree	5) My wait time in the waiting area is usually reasonable N/A
6) My wait time in the examination room before my child is seen by the provider is usually reasonable	6) My wait time in the examination room before my child is seen by the provider is usually reasonable Strongly Disagree	6) My wait time in the examination room before my child is seen by the provider is usually reasonable Disagree	6) My wait time in the examination room before my child is seen by the provider is usually reasonable Neutral	6) My wait time in the examination room before my child is seen by the provider is usually reasonable Agree	6) My wait time in the examination room before my child is seen by the provider is usually reasonable Strongly Agree	6) My wait time in the examination room before my child is seen by the provider is usually reasonable N/A
7) After my child is seen by the provider the time that we need to wait for tests to be done or vaccines to be given is reasonable.	7) After my child is seen by the provider the time that we need to wait for tests to be done or vaccines to be given is reasonable. Strongly Disagree	7) After my child is seen by the provider the time that we need to wait for tests to be done or vaccines to be given is reasonable. Disagree	7) After my child is seen by the provider the time that we need to wait for tests to be done or vaccines to be given is reasonable. Neutral	7) After my child is seen by the provider the time that we need to wait for tests to be done or vaccines to be given is reasonable. Agree	7) After my child is seen by the provider the time that we need to wait for tests to be done or vaccines to be given is reasonable. Strongly Agree	7) After my child is seen by the provider the time that we need to wait for tests to be done or vaccines to be given is reasonable. N/A
8) The nurse who works with my child is friendly and efficient	8) The nurse who works with my child is friendly and efficient Strongly Disagree	8) The nurse who works with my child is friendly and efficient Disagree	8) The nurse who works with my child is friendly and efficient Neutral	8) The nurse who works with my child is friendly and efficient Agree	8) The nurse who works with my child is friendly and efficient Strongly Agree	8) The nurse who works with my child is friendly and efficient N/A
9) My child's doctor or nurse practitioner is knowledgeable	9) My child's doctor or nurse practitioner is knowledgeable Strongly Disagree	9) My child's doctor or nurse practitioner is knowledgeable Disagree	9) My child's doctor or nurse practitioner is knowledgeable Neutral	9) My child's doctor or nurse practitioner is knowledgeable Agree	9) My child's doctor or nurse practitioner is knowledgeable Strongly Agree	9) My child's doctor or nurse practitioner is knowledgeable N/A
10) All of my questions/concerns are usually answered by my Doctor/Nurse Practitioner.	10) All of my questions/concerns are usually answered by my Doctor/Nurse Practitioner. Strongly Disagree	10) All of my questions/concerns are usually answered by my Doctor/Nurse Practitioner. Disagree	10) All of my questions/concerns are usually answered by my Doctor/Nurse Practitioner. Neutral	10) All of my questions/concerns are usually answered by my Doctor/Nurse Practitioner. Agree	10) All of my questions/concerns are usually answered by my Doctor/Nurse Practitioner. Strongly Agree	10) All of my questions/concerns are usually answered by my Doctor/Nurse Practitioner. N/A
11) My telephone calls for advice or refills or other issues are returned within a reasonable time.	11) My telephone calls for advice or refills or other issues are returned within a reasonable time. Strongly Disagree	11) My telephone calls for advice or refills or other issues are returned within a reasonable time. Disagree	11) My telephone calls for advice or refills or other issues are returned within a reasonable time. Neutral	11) My telephone calls for advice or refills or other issues are returned within a reasonable time. Agree	11) My telephone calls for advice or refills or other issues are returned within a reasonable time. Strongly Agree	11) My telephone calls for advice or refills or other issues are returned within a reasonable time. N/A
12) My prescriptions are sent to my pharmacy promptly	12) My prescriptions are sent to my pharmacy promptly Strongly Disagree	12) My prescriptions are sent to my pharmacy promptly Disagree	12) My prescriptions are sent to my pharmacy promptly Neutral	12) My prescriptions are sent to my pharmacy promptly Agree	12) My prescriptions are sent to my pharmacy promptly Strongly Agree	12) My prescriptions are sent to my pharmacy promptly N/A
13) Overall, I am satisfied with my experience at the clinic.	13) Overall, I am satisfied with my experience at the clinic. Strongly Disagree	13) Overall, I am satisfied with my experience at the clinic. Disagree	13) Overall, I am satisfied with my experience at the clinic. Neutral	13) Overall, I am satisfied with my experience at the clinic. Agree	13) Overall, I am satisfied with my experience at the clinic. Strongly Agree	13) Overall, I am satisfied with my experience at the clinic. N/A
14) I would highly recommend Rainbow Kids Clinic to others	14) I would highly recommend Rainbow Kids Clinic to others Strongly Disagree	14) I would highly recommend Rainbow Kids Clinic to others Disagree	14) I would highly recommend Rainbow Kids Clinic to others Neutral	14) I would highly recommend Rainbow Kids Clinic to others Agree	14) I would highly recommend Rainbow Kids Clinic to others Strongly Agree	14) I would highly recommend Rainbow Kids Clinic to others N/A

3. Please use the space below to add any comments you may have.

Please use the space below to add any comments you may have.