* 1. How likely is it that you would recommend our practice to a friend or colleague?


* 2. Overall, how satisfied or dissatisfied are you with our practice?

* 3. The nurses, receptionists, and other staff treat my child and family with respect and care.

* 4. When I phoned this doctor's office to get an appointmentfor care I needed right away, I got an appointment as soon as I thought I needed it.

* 5. When I phone the office, I get an answer to my medical question that same day.

* 6. The doctor treats my child and family with respect and listens to me carefully.

* 7. My child's doctor gave me easy to understand instructions about how to take care of my child's health problems or concerns.

* 8. When my child's doctor orders blood tests, x-rays, or other tests, someone from the office follow up to give me the results.

* 9. My child's doctor communicates with other health care professionals about my child's care (such as specialist, therapists, or other agencies)

* 10. Please tell us about anything that was done well or anything that could have improved the care and services you received. You may also state any other comments or concerns.