Carteret Children's Clinic Patient Survey Question Title * 1. Our records show that your child got care from one of our healthcare provider's. Please choose the provider that you received care from. Margaret Merrick, MD Loreli Rowe, MD Kathy Moorehead, MD Robin Gillikin, FNP Melanie Johnston, PNP Kourtney Sloan, PMHNP Karen McNair, LPC Bonnie Weeks OK Question Title * 2. How long has it been since your most recent visit with your healthcare provider? Less than 1 month At least 1 month but less than 3 months At least 3 months but less than 6 months At least 6 months but less than 12 months 12 months or more OK Question Title * 3. How long have you been coming to a healthcare provider at our office? Less than 6 months At least 6 months but less than 1 year At least 1 year but less than 3 years At least 3 years but less than 5 years 5 years or more OK Question Title * 4. In the last 12 months, did you phone your healthcare provider’s office to get an appointment for an illness, injury, or condition that needed care right away? (If no go to # 7) Yes No OK Question Title * 5. In the last 12 months, when you phoned your healthcare provider’s office to get an appointment for care you needed right away, how often did you get an appointment as soon as you needed? Never Sometimes Usually Always OK Question Title * 6. In the last 12 months, did you make any appointments for a check up or routine care with your healthcare provider? (If no go to #9) Yes No OK Question Title * 7. In the last 12 months, when you made an appointment for a check-up or routine care with your healthcare provider, how often did you get an appointment as soon as you needed? Never Sometimes Usually Always OK Question Title * 8. In the last 12 months, when you phoned or messaged the triage nurse during regular office hours, how often did you get an answer to your medical question that same day? Never Sometimes Usually Always N/A OK Question Title * 9. In the last 12 months, when you phoned the after hours provider on call , did you get an answer to your medical question as soon as you needed? Never Sometimes Usually Always N/A OK Question Title * 10. Wait time includes time spent in the waiting room and exam room. In the last 12 months, how often did you see your healthcare provider within 30 minutes of your appointment time for a sick visit? Never Sometimes Usually Always OK Question Title * 11. During your most recent visit, did your healthcare provider explain things in a way that was easy to understand? Yes, definitely Yes, somewhat No OK Question Title * 12. During your most recent visit, did your healthcare provider listen carefully to you? Yes, definitely Yes, somewhat No OK Question Title * 13. During your most recent visit, did you talk with your healthcare provider about any health questions or concerns? Yes No OK Question Title * 14. During your most recent visit, did your healthcare provider show respect for what you had to say? Yes, definitely Yes, somewhat No OK Question Title * 15. During your most recent visit, did your healthcare provider give you easy to understand information about these health questions or concerns? Yes, definitely Yes, somewhat No OK Question Title * 16. During your most recent visit, did your healthcare provider spend enough time with you? Yes, definitely Yes, somewhat No OK Question Title * 17. Using any number from 0 to 10, where 0 is the worst provider possible and 10 is the best provider possible, what number would you use to rate your healthcare provider? 10 Best provider possible 9 8 7 6 5 4 3 2 1 0 Worst provider possible . . 10 Best provider possible . 9 . 8 . 7 . 6 . 5 . 4 . 3 . 2 . 1 . 0 Worst provider possible OK Question Title * 18. Would you recommend our office to your family and friends? Yes, definitely Yes, somewhat No OK Question Title * 19. During your most recent visit, were the receptionists as helpful as you thought they should be? Yes, definitely Yes, somewhat No OK Question Title * 20. During your most recent visit, did nurses and medical assistant's treat you with courtesy and respect? Yes, definitely Yes, somewhat No OK Question Title * 21. During your most recent visit, did your healthcare provider order a blood test, x-ray, or other test for you? If no skip to question #23. Yes No OK Question Title * 22. Did someone from your healthcare provider’s office follow up to give you those results? Yes No N/A OK Question Title * 23. In the last 12 months, how many times did you visit your healthcare provider? None 1 time 2 3 4 5 to 9 10 or more times OK Question Title * 24. In the last 12 months has your healthcare provider referred you to a specialist? If no skip to question # 25 Yes No OK Question Title * 25. Did someone from your healthcare provider's office assist you in coordinating/scheduling your referral appointment? Yes No N/A OK Question Title * 26. During your most recent visit, did your healthcare provider seem to know the important information about your medical history? Yes, definitely Yes, somewhat No OK Question Title * 27. In general, how would you rate your child's overall health? Excellent Very good Good Fair Poor OK Question Title * 28. In general, how would you rate your child's overall mental or emotional health? Excellent Very good Good Fair Poor OK Question Title * 29. What is the highest grade or level of school that you have completed? 8th grade or less Some high school, but did not graduate High school graduate or GED Some college or 2-year degree 4-year college graduate More than 4-year college degree OK Question Title * 30. Is your child of Hispanic or Latino origin or descent? Yes, Hispanic or Latino No, not Hispanic or Latino OK Question Title * 31. Is your child male or female? Male Female OK Question Title * 32. What is your child's race? Mark one or more. White Black or African American Asian Native Hawaiian or Other Pacific Islander American Indian or Alaska Native Other OK Question Title * 33. Is the healthcare provider you saw, the provider you usually see if you need a physical, want advice about a health problem, or get sick or hurt? Yes No OK Question Title * 34. Did someone help you complete this survey? Yes No OK Question Title * 35. How did that person help you? Mark one or more. Read the questions to me Wrote down the answers I gave Answered the questions for me Translated the questions into my language Helped in some other way OK Question Title * 36. Please leave comments , suggestions or concerns. Thank you! OK DONE