Kidzcare Pediatrics Patient Satisfaction Survey Question Title * 1. Please select your Kidzcare Pediatrics -Patient Centered Medical Home location for this survey -feedback Burlington, NC Charlotte - Eastover Medical Plaza, NC Charlotte - Sharon Amity, NC Fayetteville -All American, NC Fayetteville- Cape Fear, NC Fayetteville -Yadkin, NC Fayetteville -Northside, NC Franklin, NC Hampstead, NC Hope Mills, NC Greensboro, NC Leland, NC Lillington, NC Sanford, NC Saint Pauls, NC Spring Lake, NC Wilmington, NC Other (please specify) Question Title * 2. date of your visit Date of you visit Date Question Title * 3. New or Established Patient? New Patient Established Patient Question Title * 4. Type of visit? Well visit/Physical Scheduled Sick- f/u Visit Walk in sick visit Question Title * 5. At what email address would you like to be contacted? Question Title * 6. How friendly is your doctor's office Front Desk -Registration staff? Extremely friendly Very friendly Moderately friendly Slightly friendly Not at all friendly Question Title * 7. Overall, how easy do you find it to schedule appointments? Extremely Easy Very Easy Moderately Easy Slightly Easy Not at all-Easy Question Title * 8. How quickly did our Front Desk staff return your phone calls? Extremely Quickly Very Quickly Moderately Quickly Slightly Quickly Not Quickly at all Question Title * 9. How easy was the check-in and registration process? Extremely Easy Very Easy Moderately Easy Slightly Easy Not Easy at all Question Title * 10. Any other comment -feedback for front desk team? Question Title * 11. How was the cleanliness of the Front Office -Lobby waiting space? Extremely Clean Very Clean Moderately Clean Slightly Clean Not Clean at all Question Title * 12. How comfortable is the Front Office waiting space? Extremely comfortable Very comfortable Moderately comfortable Slightly comfortable Not comfortable at all Question Title * 13. Was this visit a pleasant / friendly experience for your child? Extremely Pleasant Very Pleasant Moderately Pleasant Slightly Pleasant Not Pleasant at all Question Title * 14. How convenient are the facility's office hours? Extremely Convenient Very Convenient Moderately Convenient Slightly Convenient Not Convenient at all Question Title * 15. Any other feedback for Front Office or Facility hours of operations? Question Title * 16. How courteous -friendly was the triage and nursing staff member who provided care to your child? Extremely Courteous Very Courteous Moderately Courteous Slightly Courteous Not Courteous at all Question Title * 17. How interested was the nursing and triage staff in your child's comfort? Extremely Interested Very Interested Moderately Interested Slightly Interested Not Interested at all Question Title * 18. How helpful was triage and nursing staff in answering your questions / concerns? Extremely helpful Very helpful Moderately helpful Slightly helpful Not helpful at all Question Title * 19. Overall, how often do you wait more than 15 minutes to see your nurse/medical assistant? (Wait time includes time spent in the waiting room/Lobby.) Always Most of the time About half of the time Once in a while Never Question Title * 20. Any feedback for the triage and nursing staff? Question Title * 21. How courteous was the Doctor who provided treatment for your child? Extremely Courteous Very Courteous Moderately Courteous Slightly Courteous Not Courteous at all Question Title * 22. How was the quality of time spent by the Doctor with your child? Extremely Reasonable Very Reasonable Moderately Reasonable Slightly Reasonable Not Reasonable at all Question Title * 23. How concerned was the Doctor with your child's care? Extremely Concerned Very Concerned Moderately Concerned Slightly Concerned Not Concerned at all Question Title * 24. Did your Doctor / Provider explain to you about your child's visit and answer your questions? Extremely Well Very Well Moderately Well Slightly Well Not Well at all Question Title * 25. Overall, how often do you wait more than 15 minutes to see your doctor? (wait time spent in the exam room) Always Most of the time About half of the time Once in a while Never Question Title * 26. Any Feedback or comments on your Doctor /provider ? Question Title * 27. How was our concern of your child's privacy? Extremely Concerned Very Concerned Moderately Concerned Slightly Concerned Not Concerned at all Question Title * 28. How was our sensitivity towards you and your child's needs? Extremely Sensitive Very Sensitive Moderately Sensitive Slightly Sensitive Not Sensitive at all Question Title * 29. How was our response to your complaints and concerns made during your visit? Extremely Responsive Very Responsive Moderately Responsive Slightly Responsive Not Responsive at all Not Applicable Question Title * 30. Any feedback or comments? Question Title * 31. How courteous was billing staff who processed your insurance/ bill? Extremely Courteous Very Courteous Moderately Courteous Slightly Courteous Not Courteous at all Question Title * 32. How was your privacy experience with billing staff while gathering your insurance/ billing information? Extremely Private Very Private Moderately Private Slightly Private Not Private at all Question Title * 33. How helpful and supportive was the billing staff while processing your insurance/ billing? Extremely Helpful and Supportive Very Helpful and Supportive Moderately Helpful and Supportive Slightly Helpful and Supportive Not Helpful and Supportive at all Question Title * 34. Any feedback for insurance/ billing? Question Title * 35. Did you hear about our patient portal and its benefits (24 hour access to your medical records, medications, immunization, growth charts, lab results, prescription requests, visit summary etc),? Yes heard from FD/MA-Nursing / Provider-Doctor-other staff Yes heard about it and signed up Heard about it but did not sign up No did not hear about it No but I would like more information about it Other (please specify) Question Title * 36. Overall, how well did the staff work together to provide care and treatment to your child? Extremely Well Very Well Moderately Well Slightly Well Not Well at all Question Title * 37. How do you rate the overall care received during your visit? Extremely Pleased Very Pleased Moderately Pleased Slightly Pleased Not Pleased at all Question Title * 38. How likely are you to continue your visits in our clinic in the future? Extremely Likely Very Likely Moderately Likely Slightly Likely Not Likely at all Question Title * 39. How likely are you to recommend our facility to others? Extremely Likely Very Likely Moderately Likely Slightly Likely Not Likely at all Question Title * 40. Any feedback or suggestions to improve our facility and care provided to you and your child? Done