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In order to understand and improve the quality of service Starlight Pediatrics (SLP) provides to our patients and caregivers, we invite you to tell us about your experience during your visit today by filling out this patient/caregiver satisfaction survey. Participation is completely voluntary. If you choose to participate, please leave the survey in the exam room before you leave or place it in the survey box located in the waiting room.

Thank you for helping us improve our practice!

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* 1. Scheduling this appointment was quick and easy-

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* 2. An appointment was available for when I wanted to be seen-

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* 3. The wait time, in the waiting room, prior to the visit was appropriate-

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* 4. The wait time, in the exam room, prior to being seen was appropriate-

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* 5. The wait time for tests/procedures/vaccines to be performed was appropriate-

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* 6. All questions were answered and education was given regarding conditions/medications/ procedures/etc.

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* 7. Education was given by (please check all that apply):

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* 8. Education was given (please check all that apply):

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* 9. The provider and the nurse I/we worked with today was (Select ALL that apply)

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* 10. Was there anything exceptionally good or bad about today’s visit? Any additional comments? If you'd like a follow up, please leave your name and contact information.

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