Angel Kids Pediatrics Patient Satisfaction Survey We are interested in knowing how you feel about your patient experience at our practice. Your assistance is extremely important in helping us continue to provide excellent patient care. Question Title * 1. Which office did you visit today? Bartram Office Atlantic Office Beach Blvd Office Julington Creek Office Normandy Office Northside Office Ponte Vedra Office Telehealth Please rate the following: Question Title * 2. The ability to schedule an appointment promptly Excellent Good Fair Poor Excellent Good Fair Poor Additional comments Question Title * 3. The convenience of the office location Excellent Good Fair Poor Excellent Good Fair Poor Additional comments Question Title * 4. The accessibility of the office. Is it easy to find? Excellent Good Fair Poor Excellent Good Fair Poor Additional comments Question Title * 5. Is our office ADA (Americans with Disability Act) compliant (if applicable? Excellent Good Fair Poor Unknown N/A Excellent Good Fair Poor Unknown N/A Additional comments Question Title * 6. The comfort and attractiveness of the reception area Excellent Good Fair Poor Excellent Good Fair Poor Additional comments Question Title * 7. The comfort of the examination rooms Excellent Good Fair Poor Excellent Good Fair Poor Additional comments Question Title * 8. The cleanliness of the office including the reception area and the examination rooms Excellent Good Fair Poor Excellent Good Fair Poor Additional comments Question Title * 9. The courtesy and attentiveness of the staff Excellent Good Fair Poor Excellent Good Fair Poor Additional comments Question Title * 10. How long was your wait time from Check-in to getting into an Exam Room Less than 10 minutes 10 to 30 minutes 30 to 60 minutes More than 60 minutes Additional Comments Question Title * 11. Which provider did you see? Question Title * 12. The amount of time spent with your physician / communication with the physician and the quality of care received. Excellent Good Fair Poor Excellent Good Fair Poor Additional comments Question Title * 13. Overall, how would you rate your experience? Excellent Good Fair Poor Excellent Good Fair Poor Additional comments Question Title * 14. How likely are you to recommend us to others very likely somewhat likely Neutral somewhat unlikely very unlikely very likely somewhat likely Neutral somewhat unlikely very unlikely Question Title * 15. Do you have any additional comments? Question Title * 16. If you would like to receive a follow-up call from our office, please provide your information below. Name (please include patient name) Email Address Phone Number Done