We value your feedback!

Please think of the last visit your child had to one of our locations. Use that experience to answer the following questions. Thank you for your time.

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* 1. Please tell us which location you visited.

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* 2. Please let us know when you were seen (or your best guess)

Date

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* 4. Access: please rate how you felt about your access to care, advice, and other assistance.

  Completely Satisfied Satisfied Neutral Dissatisfied Completely Dissatisfied N/A
Appointment availability within a reasonable timeframe
Getting advice/help during office hours
Getting after-hours care
Received appointment for urgent care in timely manner
Received appointment for non-urgent care in timely manner
Medical questions were answered within 24 hours
Ability for office staff to assist you

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* 5. Communication: please rate how you felt about communication with the office (both staff and providers).

  Completely Satisfied Satisfied Neutral Dissatisfied Completely Dissatisfied N/A
Willingness to listen carefully to you/your child
Taking time to answer your questions so that you could understand
Office staff was courteous and respectful

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* 6. Coordination of Care: please rate how you felt about the care you received in a team setting, including any coordinating for outside care.

  Completely Satisfied Satisfied Neutral Dissatisfied Completely Dissatisfied N/A
The way your provider involves outside providers in your/your child's care
Provider's knowledge about tests ordered outside of the office
Provider's explanation of how best to follow your/your child's plan of care
Ability of provider and/or office to assist in follow up care

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* 7. Whole Person Care/Self Management: please rate how you felt about receiving overall care.

  Completely Satisfied Satisfied Neutral Dissatisfied Completely Dissatisfied N/A
Advice given to you on ways to stay healthy
The way you were taught about improving your/your child's health

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* 8. How old is the patient for whom this survey is being completed?

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* 9. Who is completing this survey?

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* 10. Do you have any other feedback you'd like to share?

0 of 10 answered
 

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