At Advanced Pediatric Associates our goal is to provide patients with excellent care and outstanding customer service.  We value your opinion and will use results from this survey to help identify areas where we might improve our service.  Your responses are HIPAA secure and completely confidential.
* Denotes required field

* Patient(s) Age (Select all that apply):

* Does your feedback pertain to a specific visit date?  If yes, please provide the date:

Date / Time
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* Which office are you evaluating in this survey? (Select one):

Please rate the following aspects of your child’s care by selecting the response that best describes your experience.  Space is provided at the end of this survey for you to comment on your responses or provide additional feedback regarding your experience with our practice.

* Overall satisfaction with Advanced Pediatric Associates:

* Likelihood of you recommending Advanced Pediatric Associates to others:

* Scheduling of Appointment

  Very Poor
Poor
Fair
Good
Very Good
Not Applicable
Wait time on phone before speaking to scheduler:
Friendliness / helpfulness of scheduler:
Availability of convenient appointment time:
Ability to schedule appointment with acceptable choice of provider:
Overall satisfaction with appointment scheduling:

* Arrival and Check-In

  Very Poor
Poor
Fair
Good
Very Good
Not Applicable
Friendliness / helpfulness of reception staff:
Wait time before being taken to exam room:
Communication of any delays from reception staff:
Cleanliness / comfort of reception area:
Overall satisfaction with arrival and check-in:

* Care by Medical Assistant (MA)

  Very Poor
Poor
Fair
Good
Very Good
Not Applicable
Friendliness / ability of MA to make your child feel at ease:
Communication from MA on how soon the provider would see you:
Competence / compassion demonstrated by MA in administering any immunizations / lab tests:
Overall satisfaction with medical assistant (MA):

* Care by Physician / Provider

  Very Poor
Poor
Fair
Good
Very Good
Not Applicable
Wait time for provider to enter exam room:
Friendliness / ability of provider to make your child feel at ease:
Amount of time provider gave you to ask questions:
Concern that provider showed for your questions or worries:
Degree to which provider spoke with you in words you could understand:
Provider's efforts to include you in decisions about your child's treatment:
Degree to which written instructions / printed handouts were helpful and easy to understand:
Amount of time provider spent with you and your child:
Your confidence in this provider:
Likelihood of you recommending this provider to others:
Overall satisfaction with physician / provider:

* Nurse Line

  Very Poor
Poor
Fair
Good
Very Good
Not Applicable
Wait time on telephone before speaking with nurse:
Friendliness / compassion of nurse:
Helpfulness of nurse advice:
Overall satisfaction with nurse line:

* After-Hours Service

  Very Poor
Poor
Fair
Good
Very Good
Not Applicable
Friendliness / courtesy of answering service:
Wait time to receive callback from after-hours nurse:
Friendliness / compassion of after-hours nurse:
Satisfaction with advice / care instructions from after-hours nurse:
Satisfaction with your ability to speak with on-call physician (if applicable):
Wait time for a return call from on-call physician (if applicable):
Friendliness / courtesy of on-call physician (if applicable):
Satisfaction with advice / care instructions from on-call physician (if applicable):
Overall satisfaction with after-hours service:

* Additional Services / Issues

  Very Poor
Poor
Fair
Good
Very Good
Not Applicable
Wait time for a return call after leaving a message for a provider (during business hours):
Wait time for lab test or x-ray results:
Satisfaction with process of making referrals to specialists:
Satisfaction with making prescription refill requests over the phone:
Satisfaction with using MyChart patient portal:
Satisfaction with Saturday office hours:
Satisfaction with the parking at Advanced Pediatric Associates:

* Patient Financial Services

  Very Poor
Poor
Fair
Good
Very Good
Not Applicable
Ease of understanding billing statement:
Ease of reaching patient financial services staff over the phone (if applicable):
Friendliness / helpfulness of patient financial services staff:
Overall satisfaction with patient financial services:

* Patient's Name (optional):

* Parent or Guardian's Name (optional):

* Telephone Number (optional):

* Email Address (optional):

* Do you have any additional comments or suggestions about how we might improve our services to you?

Thank you for taking time to complete our patient satisfaction survey!  Your responses provide valuable feedback to our staff and allow us to improve service to our patients.

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