Patient Satisfaction Survey

We are interested in receiving your feedback about the care we provide so we can ensure we are meeting your needs. Please take a moment to complete this survey. All responses will be kept confidential and anonymous. Thank you for your time!

	Great	Good	Okay	Fair	Poor	N/A
For a sick child visit: Able to get an appointment within a reasonable amount of time	For a sick child visit: Able to get an appointment within a reasonable amount of time Great	For a sick child visit: Able to get an appointment within a reasonable amount of time Good	For a sick child visit: Able to get an appointment within a reasonable amount of time Okay	For a sick child visit: Able to get an appointment within a reasonable amount of time Fair	For a sick child visit: Able to get an appointment within a reasonable amount of time Poor	For a sick child visit: Able to get an appointment within a reasonable amount of time N/A
For a well visit: Able to get an appointment within a reasonable amount of time	For a well visit: Able to get an appointment within a reasonable amount of time Great	For a well visit: Able to get an appointment within a reasonable amount of time Good	For a well visit: Able to get an appointment within a reasonable amount of time Okay	For a well visit: Able to get an appointment within a reasonable amount of time Fair	For a well visit: Able to get an appointment within a reasonable amount of time Poor	For a well visit: Able to get an appointment within a reasonable amount of time N/A
Ability to see the provider of your choice	Ability to see the provider of your choice Great	Ability to see the provider of your choice Good	Ability to see the provider of your choice Okay	Ability to see the provider of your choice Fair	Ability to see the provider of your choice Poor	Ability to see the provider of your choice N/A
Waiting time in the reception area (past your appointment time)	Waiting time in the reception area (past your appointment time) Great	Waiting time in the reception area (past your appointment time) Good	Waiting time in the reception area (past your appointment time) Okay	Waiting time in the reception area (past your appointment time) Fair	Waiting time in the reception area (past your appointment time) Poor	Waiting time in the reception area (past your appointment time) N/A
Waiting time in the exam room	Waiting time in the exam room Great	Waiting time in the exam room Good	Waiting time in the exam room Okay	Waiting time in the exam room Fair	Waiting time in the exam room Poor	Waiting time in the exam room N/A
Keeping you informed of any delays with your appointment	Keeping you informed of any delays with your appointment Great	Keeping you informed of any delays with your appointment Good	Keeping you informed of any delays with your appointment Okay	Keeping you informed of any delays with your appointment Fair	Keeping you informed of any delays with your appointment Poor	Keeping you informed of any delays with your appointment N/A
Ease in reaching our office by phone	Ease in reaching our office by phone Great	Ease in reaching our office by phone Good	Ease in reaching our office by phone Okay	Ease in reaching our office by phone Fair	Ease in reaching our office by phone Poor	Ease in reaching our office by phone N/A
If your call required a return call from a nurse, the call was returned in a reasonable amount of time	If your call required a return call from a nurse, the call was returned in a reasonable amount of time Great	If your call required a return call from a nurse, the call was returned in a reasonable amount of time Good	If your call required a return call from a nurse, the call was returned in a reasonable amount of time Okay	If your call required a return call from a nurse, the call was returned in a reasonable amount of time Fair	If your call required a return call from a nurse, the call was returned in a reasonable amount of time Poor	If your call required a return call from a nurse, the call was returned in a reasonable amount of time N/A
If your call required a return call from a provider, the call was returned in a reasonable amount of time	If your call required a return call from a provider, the call was returned in a reasonable amount of time Great	If your call required a return call from a provider, the call was returned in a reasonable amount of time Good	If your call required a return call from a provider, the call was returned in a reasonable amount of time Okay	If your call required a return call from a provider, the call was returned in a reasonable amount of time Fair	If your call required a return call from a provider, the call was returned in a reasonable amount of time Poor	If your call required a return call from a provider, the call was returned in a reasonable amount of time N/A

Great

Good

Okay

Fair

Poor

N/A

For a sick child visit: Able to get an appointment within a reasonable amount of time

For a sick child visit: Able to get an appointment within a reasonable amount of time Great

For a sick child visit: Able to get an appointment within a reasonable amount of time Good

For a sick child visit: Able to get an appointment within a reasonable amount of time Okay

For a sick child visit: Able to get an appointment within a reasonable amount of time Fair

For a sick child visit: Able to get an appointment within a reasonable amount of time Poor

For a sick child visit: Able to get an appointment within a reasonable amount of time N/A

For a well visit: Able to get an appointment within a reasonable amount of time

For a well visit: Able to get an appointment within a reasonable amount of time Great

For a well visit: Able to get an appointment within a reasonable amount of time Good

For a well visit: Able to get an appointment within a reasonable amount of time Okay

For a well visit: Able to get an appointment within a reasonable amount of time Fair

For a well visit: Able to get an appointment within a reasonable amount of time Poor

For a well visit: Able to get an appointment within a reasonable amount of time N/A

Ability to see the provider of your choice

Ability to see the provider of your choice Great

Ability to see the provider of your choice Good

Ability to see the provider of your choice Okay

Ability to see the provider of your choice Fair

Ability to see the provider of your choice Poor

Ability to see the provider of your choice N/A

Waiting time in the reception area (past your appointment time)

Waiting time in the reception area (past your appointment time) Great

Waiting time in the reception area (past your appointment time) Good

Waiting time in the reception area (past your appointment time) Okay

Waiting time in the reception area (past your appointment time) Fair

Waiting time in the reception area (past your appointment time) Poor

Waiting time in the reception area (past your appointment time) N/A

Waiting time in the exam room

Waiting time in the exam room Great

Waiting time in the exam room Good

Waiting time in the exam room Okay

Waiting time in the exam room Fair

Waiting time in the exam room Poor

Waiting time in the exam room N/A

Keeping you informed of any delays with your appointment

Keeping you informed of any delays with your appointment Great

Keeping you informed of any delays with your appointment Good

Keeping you informed of any delays with your appointment Okay

Keeping you informed of any delays with your appointment Fair

Keeping you informed of any delays with your appointment Poor

Keeping you informed of any delays with your appointment N/A

Ease in reaching our office by phone

Ease in reaching our office by phone Great

Ease in reaching our office by phone Good

Ease in reaching our office by phone Okay

Ease in reaching our office by phone Fair

Ease in reaching our office by phone Poor

Ease in reaching our office by phone N/A

If your call required a return call from a nurse, the call was returned in a reasonable amount of time

If your call required a return call from a nurse, the call was returned in a reasonable amount of time Great

If your call required a return call from a nurse, the call was returned in a reasonable amount of time Good

If your call required a return call from a nurse, the call was returned in a reasonable amount of time Okay

If your call required a return call from a nurse, the call was returned in a reasonable amount of time Fair

If your call required a return call from a nurse, the call was returned in a reasonable amount of time Poor

If your call required a return call from a nurse, the call was returned in a reasonable amount of time N/A

If your call required a return call from a provider, the call was returned in a reasonable amount of time

If your call required a return call from a provider, the call was returned in a reasonable amount of time Great

If your call required a return call from a provider, the call was returned in a reasonable amount of time Good

If your call required a return call from a provider, the call was returned in a reasonable amount of time Okay

If your call required a return call from a provider, the call was returned in a reasonable amount of time Fair

If your call required a return call from a provider, the call was returned in a reasonable amount of time Poor

If your call required a return call from a provider, the call was returned in a reasonable amount of time N/A

Patient Satisfaction Survey

Question Title

* Access to Care