* 1. How old is your child?

* 2. In the last 12 months, how often was your child able to be seen in the practice when they needed care?

* 3. Would you allow your child to play with toys available in the patient waiting room (train table, toy castle, and books)?

* 4. In the last 12 months, how often did your child receive care at an urgent care facility?

* 5. In the last 12 months, when you phoned The Pediatric Center during regular office hours, how often did you get an answer to your medical question that same day?

* 6. In the last 12 months, how often was the wait time to be seen by the provider reasonable?

* 7. While visiting The Pediatric Center, how often was the Front Office Staff friendly and courteous to you?

* 8. While visiting The Pediatric Center, how often did the nursing staff listen carefully to you?

* 9. While visiting The Pediatric Center, how often did the nursing staff treat you with courtesy and respect?

* 10. While receiving care at The Pediatric Center, how often did the provider listen to your concerns and answer your questions?

* 11. In the last 12 months, was your child admitted to the hospital or needed care of a specialist for which the practice made a referral?

* 12. If you answered yes to the previous question, how often does your doctor seem informed and up-to-date about the care you got from specialist doctors or other doctors outside the practice?

* 13. If you had a newborn in the past 12 months, were you pleased with the care provided by the Pediatric Hospitalist service while you were in the nursery?

* 14. While receiving care at The Pediatric Center, how often did you receive instructions on how to care for your child’s specific illness or condition?

* 15. Would you recommend The Pediatric Center to your family and friends?

* 16. General Comments about your visit or experience:

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