Thank You for Choosing Promise Pediatrics!
How Was Your Recent Visit?
We appreciate you taking the time to let us know how we're doing.
1.
Please rate the friendliness of our reception staff below.
Very Unfriendly
Somewhat Unfriendly
N/A
Somewhat Friendly
Very Friendly
Very Unfriendly
Somewhat Unfriendly
N/A
Somewhat Friendly
Very Friendly
2.
Please rate the helpfulness of our nursing staff below.
Very Unhelpful
Somewhat Unhelpful
N/A
Somewhat Helpful
Very Helpful
Very Unhelpful
Somewhat Unhelpful
N/A
Somewhat Helpful
Very Helpful
3.
Please rate the satisfaction of your visit with the provider you saw below.
Very Dissatisfied
Somewhat Dissatisfied
N/A
Somewhat Satisfied
Very Satisfied
Very Dissatisfied
Somewhat Dissatisfied
N/A
Somewhat Satisfied
Very Satisfied
4.
Please rate the cleanliness of our office below.
Very Unclean
Somewhat Unclean
N/A
Somewhat Clean
Very Clean
Very Unclean
Somewhat Unclean
N/A
Somewhat Clean
Very Clean
5.
How did you hear about us?
Hospital (Please list which hospital in comment box below this question)
Other Medical Office (Please list which medical office in comment box below this question)
Facebook
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Billboard
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Friend/Family Member (Please list friend/family member in comment box below this question)
Tell us who referred you below!
6.
Please list any concerns/comments you might have for us below.
