Patient Satisfactory Survey

Concerning Your Last Appointment

We at Kids Doc Pediatrics want to give you the best possible medical care! To do that, we need your feedback. Please let us know what you think we’re doing right, and how we can improve, by filling out a patient survey. All of your responses will be kept strictly confidential, and your signature is not required. So please use this opportunity to respond freely.
1.Please answer accordingly
Strongly Agree
Agree
Neither Agree or Disagree
Disagree
Strongly Disagree
Appointments are available within a reasonable amount of time.
Scheduling an appointment is efficient and convenient
2.What provider did you see at your last visit?
3.How long
Less than 5 minutes
5-15 minutes
15-25 minutes
Greater than 25 minutes
Did you wait to be taken back by a nurse once you signed in?
Did you wait in an exam room before seeing the provider?