Which office did you visit?

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* 1. Which office did you visit?

Which Clinician did you see?

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* 2. Which Clinician did you see?

Is this the Clinician you prefer to see (your "assigned PCP")?

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* 3. Is this the Clinician you prefer to see (your "assigned PCP")?

How long as you chid been a patient at Child and Adolescent Clinic?

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* 4. How long as you chid been a patient at Child and Adolescent Clinic?

Is your child here today for a sick / injury visit?

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* 5. Is your child here today for a sick / injury visit?

If YES for a sick / injury visit, when was the first appointment offered?

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* 6. If YES for a sick / injury visit, when was the first appointment offered?

Did you call our office looking for medical advice during regular office hours?

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* 7. Did you call our office looking for medical advice during regular office hours?

If YES for medical advice, did you get an answer within 12 hours, either on the phone or left on your voicemail system?

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* 8. If YES for medical advice, did you get an answer within 12 hours, either on the phone or left on your voicemail system?

Is your child here today for a well-child exam / routine checkup?

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* 9. Is your child here today for a well-child exam / routine checkup?

If YES for a well-child exam, when you scheduled, were you offered an appointment within 2 weeks?

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* 10. If YES for a well-child exam, when you scheduled, were you offered an appointment within 2 weeks?

Did the Clinician who saw your child today explain things about your child's health in a way that was easy to understand?

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* 11. Did the Clinician who saw your child today explain things about your child's health in a way that was easy to understand?

Did the Clinician who saw your child today seem informed and up-to-date about the care your child got from specialists outside our clinic?

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* 12. Did the Clinician who saw your child today seem informed and up-to-date about the care your child got from specialists outside our clinic?

Were the Receptionists as helpful, courteous, and respectful as you thought they should be?

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* 13. Were the Receptionists as helpful, courteous, and respectful as you thought they should be?

Was the Medical Assistant (the person who escorted you to the exam room) as helpful, courteous, and respectful as you thought he/she should be?

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* 14. Was the Medical Assistant (the person who escorted you to the exam room) as helpful, courteous, and respectful as you thought he/she should be?

Who was particularly helpful to you today?

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* 15. Who was particularly helpful to you today?

Did you have enough opportunity to ask questions?

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* 16. Did you have enough opportunity to ask questions?

Did all of your questions get answered?

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* 17. Did all of your questions get answered?

Did anyone offer to help make it easier to take care of your child's health?

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* 18. Did anyone offer to help make it easier to take care of your child's health?

If your child currently takes any prescription medications, did you and anyone in this Clinician's office talk about this prescription medications?

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* 19. If your child currently takes any prescription medications, did you and anyone in this Clinician's office talk about this prescription medications?

In the last 12 months, approximately how many times did this child visit any Clinician in this office?

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* 20. In the last 12 months, approximately how many times did this child visit any Clinician in this office?

Please rate this Clinician using any number from 0 to 10, where 0 is the worst Clinician possible and 10 is the best.

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* 21. Please rate this Clinician using any number from 0 to 10, where 0 is the worst Clinician possible and 10 is the best.

0 (worst) 10 (best)
i We adjusted the number you entered based on the slider’s scale.
What is the child's age who had an appointment with a Clinician today?

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* 22. What is the child's age who had an appointment with a Clinician today?

This child is covered by insurance through:

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* 23. This child is covered by insurance through:

Have you used the online Patient Portal from home (through the CandAC website)?

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* 24. Have you used the online Patient Portal from home (through the CandAC website)?

If YES you have used the patient portal, what was useful?

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* 25. If YES you have used the patient portal, what was useful?

What would make the Patient Portal more valuable for you?

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* 26. What would make the Patient Portal more valuable for you?

Other comments:

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* 27. Other comments:

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