Child & Adolescent Clinic Family Survey, May 2019

How are we doing? We want to know! After your visit, please answer these few questions.
 
Return this survey to any front desk staff person at Child & Adolescent Clinic.
Or take the survey online: www.Candac.com or use the QR code at the right
Think of your child's most recent visit to the Child & Adolescent Clinic.

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* 1. Which office did you visit?

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* 2. Which Clinician did you see?

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* 3. Please rate this Clinician using any number from 1 to 5, where 1 is the worst Clinician possible and 5 is the best.

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* 4. Is this the Clinician you prefer to see (your "assigned PCP")?

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* 5. Is your child here today for a sick / injury visit?

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* 6. If YES for a sick / injury visit, when was the first appointment offered?

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* 7. Is your child here today for a well-child exam / routine checkup?

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* 8. If YES for a well-child exam, when you scheduled, were you offered an appointment within 2 weeks?

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* 9. Did you call our office looking for Medical Advice during regular office hours?

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* 10. If YES, did you get an answer within 12 hours, either on the phone or left on your voice mail system?

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* 11. Did the Clinician who saw your child today explain things about your child's health in a way that was easy to understand?

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* 12. Did the Clinician who saw your child today seem informed and up-to-date about the care your child got from specialists outside our clinic?

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* 13. Did the clinician provide referrals for specialist and support services (Eye doctors, Ear doctors, Heart Surgeons, Skin doctors, Behavioral Health needs, etc.)

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* 14. Did the provider inform you on ways to stay healthy and improve your child's health?

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* 15. Does someone follow up with Test Results when applicable?

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* 16. Were the receptionists as helpful, courteous, and respectful as you thought they should be?

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* 17. Was the Medical Assistant (the person who escorted you to the exam room) as helpful, courteous, and respectful as you thought he/she should be?

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* 18. Who was particularly helpful to you today?

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* 19. Did you have enough opportunity to ask questions?

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* 20. Did all of your questions get answered?

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* 21. Did anyone offer to help make it easier to take care of your child's health?

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* 22. When there is a change in medication does your pediatrician discuss the change with you in an way that is clear and easy to understand?

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* 23. What is the child's age who had an appointment with a Clinician today?

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* 24. Other comments:

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