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.

Question Title

* 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

Question Title

* 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

Question Title

* 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

Question Title

* 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

Question Title

* 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

Other Website (Please list which website in comment box below this question)

Billboard

Other Advertisement (Please list which advertisement in comment box below this question)

Friend/Family Member (Please list friend/family member in comment box below this question)

Tell us who referred you below!

Question Title

* 1. Please rate the friendliness of our reception staff below.

Question Title

* 2. Please rate the helpfulness of our nursing staff below.

Question Title

* 3. Please rate the satisfaction of your visit with the provider you saw below.

Question Title

* 4. Please rate the cleanliness of our office below.

Question Title

* 5. How did you hear about us?

Question Title

* 6. Please list any concerns/comments you might have for us below.