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* 1. How satisfied are you with the wait to get an appointment?

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* 2. How satisfied are you with the convenience of the office location?

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* 3. How satisfied are you with getting through to the office by phone?

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* 4. How satisfied are you with the length of time waiting at the office to be seen?

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* 5. How satisfied are you with the time spent with the provider your child saw?

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* 6. How would you rate the provider's ability to educate you on your child's current condition/illness?

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* 7. How well do you feel like the provider has provided you with resources that help with managing your child's care?

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* 8. The personal manner (courtesy, respect, sensitivity, friendliness) of the provider you saw?

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* 9. How would you rate the provider's sensitivity to your child's special needs or concerns?

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* 10. How do you feel about the quality of the visit overall?

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* 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?

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* 12. I am delighted with everything about this practice because my expectations for service and quality of care are met or exceeded.

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* 13. In the last 12 months, how many times have you gone to the emergency room for your child's care?

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* 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?

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* 15. In the last 12 months, how often did your child get to see the provider that you wanted?

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* 16. Are you able to get appointments for your child when you choose?

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* 17. Is there anything our practice can do to improve the care and services for you and your family?

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* 18. Would you recommend this practice to others?

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* 19. What county do you live in?

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