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* 1. Which category below includes your age?

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* 2. At which practice location is your primary care physician (PCP) located?

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* 3. How satisfied were you with your last office visit with your behavioral health provider?

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* 4. Do you feel our office staff is kind, courteous, and helpful?

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* 5. How likely are you to recommend our practice to others?

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* 6. What area of our office do you feel needs the most improvement?

  Outstanding Average Below Average Needs Improvement
Phone Etiquette
Website
Referral & Billing Services
General Office Customer Service
Appointment Scheduling
Medical Provider Services

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* 7. Consider your visit(s) to our office in the last 6 months. Rate your experience for each of the following areas.

  Outstanding Average Below Average Needs Improvement
Appointment obtained that worked with your schedule
Time spent in the waiting room prior to appointment
Time spent in the exam room waiting for the clinician
Coordination of care provided by your clinician to outside specialists/resources
Your clinician’s knowledge of the care received by outside specialists/resources

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* 8. As a parent/guardian, what you would like us to be doing that we are not currently?

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* 9. How can we improve our practice as a whole?

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