Satisfaction Survey How satisfied are you with the wait to get an appointment? Question Title * 1. How satisfied are you with the wait to get an appointment? Excellent Very Good Good Fair Poor How satisfied are you with the convenience of the office location? Question Title * 2. How satisfied are you with the convenience of the office location? Excellent Very Good Good Fair Poor How satisfied are you with getting through to the office by phone? Question Title * 3. How satisfied are you with getting through to the office by phone? Excellent Very Good Good Fair Poor How satisfied are you with the length of time waiting at the office to be seen? Question Title * 4. How satisfied are you with the length of time waiting at the office to be seen? Excellent Very Good Good Fair Poor How satisfied are you with the time spent with the provider your child saw? Question Title * 5. How satisfied are you with the time spent with the provider your child saw? Excellent Very Good Good Fair Poor How would you rate the provider's ability to educate you on your child's current condition/illness? Question Title * 6. How would you rate the provider's ability to educate you on your child's current condition/illness? Excellent Very Good Good Fair Poor How well do you feel like the provider has provided you with resources that help with managing your child's care? Question Title * 7. How well do you feel like the provider has provided you with resources that help with managing your child's care? Excellent Very Good Good Fair Poor The personal manner (courtesy, respect, sensitivity, friendliness) of the provider you saw? Question Title * 8. The personal manner (courtesy, respect, sensitivity, friendliness) of the provider you saw? Excellent Very Good Good Fair Poor How would you rate the provider's sensitivity to your child's special needs or concerns? Question Title * 9. How would you rate the provider's sensitivity to your child's special needs or concerns? Excellent Very Good Good Fair Poor How do you feel about the quality of the visit overall? Question Title * 10. How do you feel about the quality of the visit overall? Excellent Very Good Good Fair Poor If you could go anywhere to get healthcare for your child, would you choose this practice or would you prefer to go somewhere else? Question Title * 11. If you could go anywhere to get healthcare for your child, would you choose this practice or would you prefer to go somewhere else? Would choose this practice Would go somewhere else Not sure I am delighted with everything about this practice because my expectations for service and quality of care are met or exceeded. Question Title * 12. I am delighted with everything about this practice because my expectations for service and quality of care are met or exceeded. Agree Disagree Not Sure In the last 12 months, how many times have you gone to the emergency room for your child's care? Question Title * 13. In the last 12 months, how many times have you gone to the emergency room for your child's care? None One Time Two Times Three or More Times In the last 12 months, was it always easy to get a referral to a specialist when you felt like your child needed one? Question Title * 14. In the last 12 months, was it always easy to get a referral to a specialist when you felt like your child needed one? Yes No Does Not Apply To Me In the last 12 months, how often did your child get to see the provider that you wanted? Question Title * 15. In the last 12 months, how often did your child get to see the provider that you wanted? Never Sometimes Frequently Are you able to get appointments for your child when you choose? Question Title * 16. Are you able to get appointments for your child when you choose? Never Sometimes Always Is there anything our practice can do to improve the care and services for you and your family? Question Title * 17. Is there anything our practice can do to improve the care and services for you and your family? Would you recommend this practice to others? Question Title * 18. Would you recommend this practice to others? Yes No Unsure What county do you live in? Question Title * 19. What county do you live in? New Hanover Brunswick Pender Columbus Sampson Other (please specify) Done