All questions are optional. Survey is anonymous unless you choose to provide your information.

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* Which provider did you see on your child's most recent visit?

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* How long has it been since your child's most recent visit with us?

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* Provider

  Strongly Disagree Disagree Neither Agree or Disagree Agree Strongly Agree
Listened carefully to you and your child
Explained things in a way that was easy to understand
Answered all questions to your satisfaction

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* Nurses and Medical Assistants

  Strongly Disagree Disagree Neither Agree or Disagree Agree Strongly Agree
Were friendly and helpful to you and your child
Answered your questions
Maintained a professional manner throughout your visit

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* Ease of Getting Care

  Strongly Disagree Disagree Neither Agree or Disagree Agree Strongly Agree
Receptionists were friendly and helpful
Received appointment at desired time
Return on non-emergency phone calls was prompt (within 24 hours)
Saw provider of your choice
Showed concern for your and your child's privacy

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* Waiting

  Strongly Disagree Disagree Neither Agree or Disagree Agree Strongly Agree
Time in waiting room was less than 30 minutes
Time in exam room was less than 30 minutes
Time waiting for test results was appropriate

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* Facility

  Strongly Disagree Disagree Neither Agree or Disagree Agree Strongly Agree
Office was neat and clean
It was easy to find where to go
My child and I were comfortable while waiting

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* How likely would to be to recommend this office to family and friends

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* What did you like the most?

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* What can we do to improve?

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* What is yours child's full name? (Optional)

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* If you would like a call, please provide your phone number:

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* Where did you hear about us?

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