PATIENT SATISFACTION SURVEY

Thank you for taking the time to complete this questionnaire. Our goal is to provide you with the best pediatric care possible. We'd like to know how you feel about our medical services, our patient-handling systems, our physicians and staff members. Your comments will help us evaluate our operations to ensure that we are truly responsive to your needs. We appreciate you letting us know how we are doing.

SOME INFORMATION ABOUT YOU:

1. How long have you been bringing your child(ren) to our practice?

SOME INFORMATION ABOUT YOU: 1. How long have you been bringing your child(ren) to our practice?

2. How many children in your family do we care for?

3. To which of our offices do you most frequently bring your child(ren)?

3. To which of our offices do you most frequently bring your child(ren)? Manchester Lakes

Lake Ridge

Patriot Square

Chantilly

4. How did you first hear about our practice?

4. How did you first hear about our practice? Relative Friend or neighbor Referred by a physician	Insurance directory Internet
Other (please specify)

PLEASE RATE THE FOLLOWING:

A. YOUR APPOINTMENT

	Excellent	Good	Fair	Poor	N/A
1. Ease of making appointments by phone	PLEASE RATE THE FOLLOWING: A. YOUR APPOINTMENT 1. Ease of making appointments by phone Excellent	1. Ease of making appointments by phone Good	1. Ease of making appointments by phone Fair	1. Ease of making appointments by phone Poor	1. Ease of making appointments by phone N/A
2. Appointment available within a reasonable amount of time	2. Appointment available within a reasonable amount of time Excellent	2. Appointment available within a reasonable amount of time Good	2. Appointment available within a reasonable amount of time Fair	2. Appointment available within a reasonable amount of time Poor	2. Appointment available within a reasonable amount of time N/A
3. Scheduling with a provider of your choice	3. Scheduling with a provider of your choice Excellent	3. Scheduling with a provider of your choice Good	3. Scheduling with a provider of your choice Fair	3. Scheduling with a provider of your choice Poor	3. Scheduling with a provider of your choice N/A
4. Getting after-hours care when you needed it	4. Getting after-hours care when you needed it Excellent	4. Getting after-hours care when you needed it Good	4. Getting after-hours care when you needed it Fair	4. Getting after-hours care when you needed it Poor	4. Getting after-hours care when you needed it N/A
5. Waiting time in the reception area	5. Waiting time in the reception area Excellent	5. Waiting time in the reception area Good	5. Waiting time in the reception area Fair	5. Waiting time in the reception area Poor	5. Waiting time in the reception area N/A
6. Waiting time in the exam room	6. Waiting time in the exam room Excellent	6. Waiting time in the exam room Good	6. Waiting time in the exam room Fair	6. Waiting time in the exam room Poor	6. Waiting time in the exam room N/A

B. OUR STAFF

	Excellent	Good	Fair	Poor	N/A
1. The friendliness and courtesy of our front desk staff	B. OUR STAFF 1. The friendliness and courtesy of our front desk staff Excellent	1. The friendliness and courtesy of our front desk staff Good	1. The friendliness and courtesy of our front desk staff Fair	1. The friendliness and courtesy of our front desk staff Poor	1. The friendliness and courtesy of our front desk staff N/A
2. The caring concern of our nurses/medical assistants	2. The caring concern of our nurses/medical assistants Excellent	2. The caring concern of our nurses/medical assistants Good	2. The caring concern of our nurses/medical assistants Fair	2. The caring concern of our nurses/medical assistants Poor	2. The caring concern of our nurses/medical assistants N/A
3. Your confidence in the advice given by the nurse when you call	3. Your confidence in the advice given by the nurse when you call Excellent	3. Your confidence in the advice given by the nurse when you call Good	3. Your confidence in the advice given by the nurse when you call Fair	3. Your confidence in the advice given by the nurse when you call Poor	3. Your confidence in the advice given by the nurse when you call N/A

C. OUR COMMUNICATION WITH YOU

	Excellent	Good	Fair	Poor	N/A
1. Your phone calls answered promptly	C. OUR COMMUNICATION WITH YOU 1. Your phone calls answered promptly Excellent	1. Your phone calls answered promptly Good	1. Your phone calls answered promptly Fair	1. Your phone calls answered promptly Poor	1. Your phone calls answered promptly N/A
2. Getting advice or help when needed during office hours	2. Getting advice or help when needed during office hours Excellent	2. Getting advice or help when needed during office hours Good	2. Getting advice or help when needed during office hours Fair	2. Getting advice or help when needed during office hours Poor	2. Getting advice or help when needed during office hours N/A
3. Your test results reported in a reasonable amount of time	3. Your test results reported in a reasonable amount of time Excellent	3. Your test results reported in a reasonable amount of time Good	3. Your test results reported in a reasonable amount of time Fair	3. Your test results reported in a reasonable amount of time Poor	3. Your test results reported in a reasonable amount of time N/A
4. Effectiveness of our health information materials	4. Effectiveness of our health information materials Excellent	4. Effectiveness of our health information materials Good	4. Effectiveness of our health information materials Fair	4. Effectiveness of our health information materials Poor	4. Effectiveness of our health information materials N/A
5. Our ability to return your calls in a timely manner	5. Our ability to return your calls in a timely manner Excellent	5. Our ability to return your calls in a timely manner Good	5. Our ability to return your calls in a timely manner Fair	5. Our ability to return your calls in a timely manner Poor	5. Our ability to return your calls in a timely manner N/A
6. Your ability to contact us after hours	6. Your ability to contact us after hours Excellent	6. Your ability to contact us after hours Good	6. Your ability to contact us after hours Fair	6. Your ability to contact us after hours Poor	6. Your ability to contact us after hours N/A
7. Your ability to obtain prescription refills by phone	7. Your ability to obtain prescription refills by phone Excellent	7. Your ability to obtain prescription refills by phone Good	7. Your ability to obtain prescription refills by phone Fair	7. Your ability to obtain prescription refills by phone Poor	7. Your ability to obtain prescription refills by phone N/A

D. OUR PROVIDERS (The Physicians and Nurse Practitioners you see)

	Excellent	Good	Fair	Poor	N/A
1. The friendliness and courtesy of our providers	D. OUR PROVIDERS (The Physicians and Nurse Practitioners you see) 1. The friendliness and courtesy of our providers Excellent	1. The friendliness and courtesy of our providers Good	1. The friendliness and courtesy of our providers Fair	1. The friendliness and courtesy of our providers Poor	1. The friendliness and courtesy of our providers N/A
2. Provider's patience and interest in your or your child's problem	2. Provider's patience and interest in your or your child's problem Excellent	2. Provider's patience and interest in your or your child's problem Good	2. Provider's patience and interest in your or your child's problem Fair	2. Provider's patience and interest in your or your child's problem Poor	2. Provider's patience and interest in your or your child's problem N/A
3. Explanations of diagnosis and treatment options	3. Explanations of diagnosis and treatment options Excellent	3. Explanations of diagnosis and treatment options Good	3. Explanations of diagnosis and treatment options Fair	3. Explanations of diagnosis and treatment options Poor	3. Explanations of diagnosis and treatment options N/A
4. Instructions regarding medications/follow-up care	4. Instructions regarding medications/follow-up care Excellent	4. Instructions regarding medications/follow-up care Good	4. Instructions regarding medications/follow-up care Fair	4. Instructions regarding medications/follow-up care Poor	4. Instructions regarding medications/follow-up care N/A
5. Confidence in their judgment and skills	5. Confidence in their judgment and skills Excellent	5. Confidence in their judgment and skills Good	5. Confidence in their judgment and skills Fair	5. Confidence in their judgment and skills Poor	5. Confidence in their judgment and skills N/A
6. Your overall satisfaction with the medical care you received	6. Your overall satisfaction with the medical care you received Excellent	6. Your overall satisfaction with the medical care you received Good	6. Your overall satisfaction with the medical care you received Fair	6. Your overall satisfaction with the medical care you received Poor	6. Your overall satisfaction with the medical care you received N/A

E. BILLING SERVICES

	Excellent	Good	Fair	Poor	N/A
1. Clear and accurate billing statements	E. BILLING SERVICES 1. Clear and accurate billing statements Excellent	1. Clear and accurate billing statements Good	1. Clear and accurate billing statements Fair	1. Clear and accurate billing statements Poor	1. Clear and accurate billing statements N/A
2. Reaching the billing office by telephone	2. Reaching the billing office by telephone Excellent	2. Reaching the billing office by telephone Good	2. Reaching the billing office by telephone Fair	2. Reaching the billing office by telephone Poor	2. Reaching the billing office by telephone N/A
3. The courtesy and friendliness of billing staff	3. The courtesy and friendliness of billing staff Excellent	3. The courtesy and friendliness of billing staff Good	3. The courtesy and friendliness of billing staff Fair	3. The courtesy and friendliness of billing staff Poor	3. The courtesy and friendliness of billing staff N/A
4. Answering your question	4. Answering your question Excellent	4. Answering your question Good	4. Answering your question Fair	4. Answering your question Poor	4. Answering your question N/A

F. OUR FACILITIES

	Excellent	Good	Fair	Poor	N/A
1. Our office hours	F. OUR FACILITIES 1. Our office hours Excellent	1. Our office hours Good	1. Our office hours Fair	1. Our office hours Poor	1. Our office hours N/A
2. Cleanliness and appearance of office	2. Cleanliness and appearance of office Excellent	2. Cleanliness and appearance of office Good	2. Cleanliness and appearance of office Fair	2. Cleanliness and appearance of office Poor	2. Cleanliness and appearance of office N/A

G. YOUR OVERALL SATISFACTION WITH:

	Excellent	Good	Fair	Poor	N/A
1. Our practice	G. YOUR OVERALL SATISFACTION WITH: 1. Our practice Excellent	1. Our practice Good	1. Our practice Fair	1. Our practice Poor	1. Our practice N/A
2. The quality of your medical care	2. The quality of your medical care Excellent	2. The quality of your medical care Good	2. The quality of your medical care Fair	2. The quality of your medical care Poor	2. The quality of your medical care N/A
3. Overall rating of care from your provider or nurse	3. Overall rating of care from your provider or nurse Excellent	3. Overall rating of care from your provider or nurse Good	3. Overall rating of care from your provider or nurse Fair	3. Overall rating of care from your provider or nurse Poor	3. Overall rating of care from your provider or nurse N/A

Would you recommend The Pediatric Group, P.C. to others?

Would you recommend The Pediatric Group, P.C. to others? Yes	No
IF NO, PLEASE TELL US WHY:

PLEASE TELL US WHAT YOU LIKE BEST ABOUT OUR PRACTICE:

IF THERE IS ANY WAY WE CAN IMPROVE OUR SERVICES TO YOU, PLEASE TELL US ABOUT IT:

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