Please select your Kidzcare Pediatrics -Patient Centered Medical Home location for this survey -feedback

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* 1. Please select your Kidzcare Pediatrics -Patient Centered Medical Home location for this survey -feedback

date of your visit

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* 2. date of your visit

Date of you visit
New or Established Patient?

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* 3. New or Established Patient?

Type of visit?

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* 4. Type of visit?

At what email address would you like to be contacted?

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* 5. At what email address would you like to be contacted?

How friendly is your doctor's office Front Desk -Registration staff?

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* 6. How friendly is your doctor's office Front Desk -Registration staff?

Overall, how easy do you find it to schedule appointments?

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* 7. Overall, how easy do you find it to schedule appointments?

How quickly did our Front Desk staff return your phone calls?

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* 8. How quickly did our Front Desk staff return your phone calls?

How easy was the check-in and registration process?

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* 9. How easy was the check-in and registration process?

Any other comment -feedback for front desk team?

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* 10. Any other comment -feedback for front desk team?

How was the cleanliness of the Front Office -Lobby waiting space?

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* 11. How was the cleanliness of the Front Office -Lobby waiting space?

How comfortable is the Front Office waiting space?

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* 12. How comfortable is the Front Office waiting space?

Was this visit a pleasant / friendly experience for your child?

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* 13. Was this visit a pleasant / friendly experience for your child?

How convenient are the facility's office hours?

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* 14. How convenient are the facility's office hours?

Any other feedback for Front Office or Facility hours of operations?

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* 15. Any other feedback for Front Office or Facility hours of operations?

How courteous -friendly was the triage and nursing staff member who provided care to your child?

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* 16. How courteous -friendly was the triage and nursing staff member who provided care to your child?

How interested was the nursing and triage staff in your child's comfort?

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* 17. How interested was the nursing and triage staff in your child's comfort?

How helpful was triage and nursing staff in answering your questions / concerns?

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* 18. How helpful was triage and nursing staff in answering your questions / concerns?

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.)

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* 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.)

Any feedback for the triage and nursing staff?

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* 20. Any feedback for the triage and nursing staff?

How courteous was the Doctor who provided treatment for your child?

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* 21. How courteous was the Doctor who provided treatment for your child?

How was the quality of time spent by the Doctor with your child?

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* 22. How was the quality of time spent by the Doctor with your child?

How concerned was the Doctor with your child's care?

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* 23. How concerned was the Doctor with your child's care?

Did your Doctor / Provider explain to you about your child's visit and answer your questions?

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* 24. Did your Doctor / Provider explain to you about your child's visit and answer your questions?

Overall, how often do you wait more than 15 minutes to see your doctor? (wait time spent in the exam room)

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* 25. Overall, how often do you wait more than 15 minutes to see your doctor? (wait time spent in the exam room)

Any Feedback or comments on your Doctor /provider ?

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* 26. Any Feedback or comments on your Doctor /provider ?

How was our concern of your child's privacy?

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* 27. How was our concern of your child's privacy?

How was our sensitivity towards you and your child's needs?

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* 28. How was our sensitivity towards you and your child's needs?

How was our response to your complaints and concerns made during your visit?

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* 29. How was our response to your complaints and concerns made during your visit?

Any feedback or comments?

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* 30. Any feedback or comments?

How courteous was billing staff who processed your insurance/ bill?

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* 31. How courteous was billing staff who processed your insurance/ bill?

How was your privacy experience with billing staff while gathering your insurance/ billing information?

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* 32. How was your privacy experience with billing staff while gathering your insurance/ billing information?

How helpful and supportive was the billing staff while processing your insurance/ billing?

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* 33. How helpful and supportive was the billing staff while processing your insurance/ billing?

Any feedback for insurance/ billing?

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* 34. Any feedback for insurance/ billing?

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),?

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* 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),?

Overall, how well did the staff work together to provide care and treatment to your child?

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* 36. Overall, how well did the staff work together to provide care and treatment to your child?

How do you rate the overall care received during your visit?

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* 37. How do you rate the overall care received during your visit?

How likely are you to continue your visits in our clinic in the future?

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* 38. How likely are you to continue your visits in our clinic in the future?

How likely are you to recommend our facility to others?

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* 39. How likely are you to recommend our facility to others?

Any feedback or suggestions to improve our facility and care provided to you and your child?

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* 40. Any feedback or suggestions to improve our facility and care provided to you and your child?

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