Patient Satisfaction SurveyPatient Satisfaction Survey

3. How did you first become aware of Tenafly Pediatrics?

How did you first become aware of Tenafly Pediatrics? friend or relative

physician

insurance directory

internet search

Lamaze class

Other (please specify)

4. Date of your last visit (estimate if necessary):

	MM		DD		YYYY
Date	Date of your last visit (estimate if necessary): Date Month	/	Day	/	Year

5. The primary office location(s) for your child's care:

The primary office location(s) for your child's care: Tenafly

Fort Lee

Clifton

Paramus

Oakland

Park Ridge

6. Please rate your experience with our front office.

	Strongly Agree	Agree	Partly Agree/Disagree	Disagree	Strongly Disagree
Your calls get through to the office on the first attempt.	*Please rate your experience with our front office. Your calls get through to the office on the first attempt. Strongly Agree	Your calls get through to the office on the first attempt. Agree	Your calls get through to the office on the first attempt. Partly Agree/Disagree	Your calls get through to the office on the first attempt. Disagree	Your calls get through to the office on the first attempt. Strongly Disagree
Your calls are answered in a courteous and helpful manner.	Your calls are answered in a courteous and helpful manner. Strongly Agree	Your calls are answered in a courteous and helpful manner. Agree	Your calls are answered in a courteous and helpful manner. Partly Agree/Disagree	Your calls are answered in a courteous and helpful manner. Disagree	Your calls are answered in a courteous and helpful manner. Strongly Disagree
Once your call is answered, your request is handled professionally.	Once your call is answered, your request is handled professionally. Strongly Agree	Once your call is answered, your request is handled professionally. Agree	Once your call is answered, your request is handled professionally. Partly Agree/Disagree	Once your call is answered, your request is handled professionally. Disagree	Once your call is answered, your request is handled professionally. Strongly Disagree
The receptionist who greets you is helpful and friendly.	The receptionist who greets you is helpful and friendly. Strongly Agree	The receptionist who greets you is helpful and friendly. Agree	The receptionist who greets you is helpful and friendly. Partly Agree/Disagree	The receptionist who greets you is helpful and friendly. Disagree	The receptionist who greets you is helpful and friendly. Strongly Disagree
The length of time you wait in the waiting room is reasonable.	The length of time you wait in the waiting room is reasonable. Strongly Agree	The length of time you wait in the waiting room is reasonable. Agree	The length of time you wait in the waiting room is reasonable. Partly Agree/Disagree	The length of time you wait in the waiting room is reasonable. Disagree	The length of time you wait in the waiting room is reasonable. Strongly Disagree

Please add any comments.

7. Please rate your experience with the nursing/medical assistant staff.

	Strongly Agree	Agree	Partly Agree/Disagree	Disagree	Strongly Disagree
The person who escorts you to the exam room is courteous and helpful.	*Please rate your experience with the nursing/medical assistant staff. The person who escorts you to the exam room is courteous and helpful. Strongly Agree	The person who escorts you to the exam room is courteous and helpful. Agree	The person who escorts you to the exam room is courteous and helpful. Partly Agree/Disagree	The person who escorts you to the exam room is courteous and helpful. Disagree	The person who escorts you to the exam room is courteous and helpful. Strongly Disagree
The length of time you wait in the exam room is reasonable.	The length of time you wait in the exam room is reasonable. Strongly Agree	The length of time you wait in the exam room is reasonable. Agree	The length of time you wait in the exam room is reasonable. Partly Agree/Disagree	The length of time you wait in the exam room is reasonable. Disagree	The length of time you wait in the exam room is reasonable. Strongly Disagree
The nursing staff answers your questions and concerns in a clear and understandable manner.	The nursing staff answers your questions and concerns in a clear and understandable manner. Strongly Agree	The nursing staff answers your questions and concerns in a clear and understandable manner. Agree	The nursing staff answers your questions and concerns in a clear and understandable manner. Partly Agree/Disagree	The nursing staff answers your questions and concerns in a clear and understandable manner. Disagree	The nursing staff answers your questions and concerns in a clear and understandable manner. Strongly Disagree
The nursing staff treats you/your child in a caring, respectful manner.	The nursing staff treats you/your child in a caring, respectful manner. Strongly Agree	The nursing staff treats you/your child in a caring, respectful manner. Agree	The nursing staff treats you/your child in a caring, respectful manner. Partly Agree/Disagree	The nursing staff treats you/your child in a caring, respectful manner. Disagree	The nursing staff treats you/your child in a caring, respectful manner. Strongly Disagree

Please feel free to comment:

8. Please check the box next to your primary physician's name:

Please check the box next to your primary physician's name: Alina Sumarokov, MD

Avigayil Elkin, MD

Aviva Schein, MD

Christine Pagano, MD

Darren Saks, MD

David Schaumberger, MD

David Wisotsky, MD

Erin Lindenberg, MD

Eun-Joo Kim, MD

Joanne Aranoff, MD

John Slater, MD

Joshua Menasha, MD

Larry Stiefel, MD

Lisa Michael, MD

Lynn Sugarman, MD

Maureen Grossi, MD

Maury Buchalter, MD

Michael Smith, MD

Raquel Bronfeld, MD

Robert Jawetz, MD

Russell Asnes, MD

Sheryl Jawetz, MD

Sunmee Kim, MD

Yvette Starer, MD

9. Please rate your experience with your primary physician.

	Strongly Agree	Agree	Partly Agree/Disagree	Disagree	Strongly Disagree
You are satisfied with the quality of care your child is receiving.	*Please rate your experience with your primary physician. You are satisfied with the quality of care your child is receiving. Strongly Agree	You are satisfied with the quality of care your child is receiving. Agree	You are satisfied with the quality of care your child is receiving. Partly Agree/Disagree	You are satisfied with the quality of care your child is receiving. Disagree	You are satisfied with the quality of care your child is receiving. Strongly Disagree
The physician answers your questions and concerns in a clear and understandable manner.	The physician answers your questions and concerns in a clear and understandable manner. Strongly Agree	The physician answers your questions and concerns in a clear and understandable manner. Agree	The physician answers your questions and concerns in a clear and understandable manner. Partly Agree/Disagree	The physician answers your questions and concerns in a clear and understandable manner. Disagree	The physician answers your questions and concerns in a clear and understandable manner. Strongly Disagree
The physician treats you/your child in a caring, respectful manner.	The physician treats you/your child in a caring, respectful manner. Strongly Agree	The physician treats you/your child in a caring, respectful manner. Agree	The physician treats you/your child in a caring, respectful manner. Partly Agree/Disagree	The physician treats you/your child in a caring, respectful manner. Disagree	The physician treats you/your child in a caring, respectful manner. Strongly Disagree
The physician sees you on time.	The physician sees you on time. Strongly Agree	The physician sees you on time. Agree	The physician sees you on time. Partly Agree/Disagree	The physician sees you on time. Disagree	The physician sees you on time. Strongly Disagree

Please feel free to add comments:

10. Please comment on the office facilities you primarily go to:

	Strongly Agree	Agree	Partial Agree/Disagree	Disagree	Strongly Disagree	N/A
The waiting room is clean and comfortable.	*Please comment on the office facilities you primarily go to: The waiting room is clean and comfortable. Strongly Agree	The waiting room is clean and comfortable. Agree	The waiting room is clean and comfortable. Partial Agree/Disagree	The waiting room is clean and comfortable. Disagree	The waiting room is clean and comfortable. Strongly Disagree	The waiting room is clean and comfortable. N/A
The exam room is clean and comfortable.	The exam room is clean and comfortable. Strongly Agree	The exam room is clean and comfortable. Agree	The exam room is clean and comfortable. Partial Agree/Disagree	The exam room is clean and comfortable. Disagree	The exam room is clean and comfortable. Strongly Disagree	The exam room is clean and comfortable. N/A
The bathroom is clean.	The bathroom is clean. Strongly Agree	The bathroom is clean. Agree	The bathroom is clean. Partial Agree/Disagree	The bathroom is clean. Disagree	The bathroom is clean. Strongly Disagree	The bathroom is clean. N/A
There is adequate parking.	There is adequate parking. Strongly Agree	There is adequate parking. Agree	There is adequate parking. Partial Agree/Disagree	There is adequate parking. Disagree	There is adequate parking. Strongly Disagree	There is adequate parking. N/A
The office hours are convenient.	The office hours are convenient. Strongly Agree	The office hours are convenient. Agree	The office hours are convenient. Partial Agree/Disagree	The office hours are convenient. Disagree	The office hours are convenient. Strongly Disagree	The office hours are convenient. N/A

Please feel free to comment below:

11. Please rate your experience with our billing staff:

	Strongly Agree	Agree	Partial Agree/Disagree	Disagree	Strongly Disagree	N/A
The bills you receive are accurate.	*Please rate your experience with our billing staff: The bills you receive are accurate. Strongly Agree	The bills you receive are accurate. Agree	The bills you receive are accurate. Partial Agree/Disagree	The bills you receive are accurate. Disagree	The bills you receive are accurate. Strongly Disagree	The bills you receive are accurate. N/A
The bills you receive are easy to understand.	The bills you receive are easy to understand. Strongly Agree	The bills you receive are easy to understand. Agree	The bills you receive are easy to understand. Partial Agree/Disagree	The bills you receive are easy to understand. Disagree	The bills you receive are easy to understand. Strongly Disagree	The bills you receive are easy to understand. N/A
The billing staff handles your questions in a courteous and helpful manner.	The billing staff handles your questions in a courteous and helpful manner. Strongly Agree	The billing staff handles your questions in a courteous and helpful manner. Agree	The billing staff handles your questions in a courteous and helpful manner. Partial Agree/Disagree	The billing staff handles your questions in a courteous and helpful manner. Disagree	The billing staff handles your questions in a courteous and helpful manner. Strongly Disagree	The billing staff handles your questions in a courteous and helpful manner. N/A

Please feel free to comment below:

12. Please answer the following question on your overall experience:

	Strongly Agree	Agree	Partial Agree/Disagree	Disagree	Strongly Disagree
I would recommend Tenafly Pediatrics to a friend or relative.	*Please answer the following question on your overall experience: I would recommend Tenafly Pediatrics to a friend or relative. Strongly Agree	I would recommend Tenafly Pediatrics to a friend or relative. Agree	I would recommend Tenafly Pediatrics to a friend or relative. Partial Agree/Disagree	I would recommend Tenafly Pediatrics to a friend or relative. Disagree	I would recommend Tenafly Pediatrics to a friend or relative. Strongly Disagree

Please feel free to add comments below:

13. Overall, is our service...

Overall, is our service... Getting much better?

Getting better?

Staying at about the same level?

Getting worse?

Getting much worse?

14. What changes would you like to see us make to improve our service to you?

What changes would you like to see us make to improve our service to you?

15. We welcome your comments on specific employees/physicians who have been particularly helpful. We also appreciate your comments on specific employees/physicians, if any, who did not address your needs.

We welcome your comments on specific employees/physicians who have been particularly helpful. We also appreciate your comments on specific employees/physicians, if any, who did not address your needs.

Patient Satisfaction Survey

Tenafly Pediatrics Patient Satisfaction Survey