Patient Satisfaction Survey All questions are optional. Survey is anonymous unless you choose to provide your information. Question Title * Which provider did you see on your child's most recent visit? Alecia Hanes, MD Katrin Green, PA-C Alex Martin, CPNP Jennifer Fulmer, CPNP Tiffany Stutzman, PA-C Question Title * How long has it been since your child's most recent visit with us? Less than a month 1-3 months 3-6 months 6-12 months 12 or more months Question Title * Provider Strongly Disagree Disagree Neither Agree or Disagree Agree Strongly Agree Listened carefully to you and your child Listened carefully to you and your child Strongly Disagree Listened carefully to you and your child Disagree Listened carefully to you and your child Neither Agree or Disagree Listened carefully to you and your child Agree Listened carefully to you and your child Strongly Agree Explained things in a way that was easy to understand Explained things in a way that was easy to understand Strongly Disagree Explained things in a way that was easy to understand Disagree Explained things in a way that was easy to understand Neither Agree or Disagree Explained things in a way that was easy to understand Agree Explained things in a way that was easy to understand Strongly Agree Answered all questions to your satisfaction Answered all questions to your satisfaction Strongly Disagree Answered all questions to your satisfaction Disagree Answered all questions to your satisfaction Neither Agree or Disagree Answered all questions to your satisfaction Agree Answered all questions to your satisfaction Strongly Agree Question Title * Nurses and Medical Assistants Strongly Disagree Disagree Neither Agree or Disagree Agree Strongly Agree Were friendly and helpful to you and your child Were friendly and helpful to you and your child Strongly Disagree Were friendly and helpful to you and your child Disagree Were friendly and helpful to you and your child Neither Agree or Disagree Were friendly and helpful to you and your child Agree Were friendly and helpful to you and your child Strongly Agree Answered your questions Answered your questions Strongly Disagree Answered your questions Disagree Answered your questions Neither Agree or Disagree Answered your questions Agree Answered your questions Strongly Agree Maintained a professional manner throughout your visit Maintained a professional manner throughout your visit Strongly Disagree Maintained a professional manner throughout your visit Disagree Maintained a professional manner throughout your visit Neither Agree or Disagree Maintained a professional manner throughout your visit Agree Maintained a professional manner throughout your visit Strongly Agree Question Title * Ease of Getting Care Strongly Disagree Disagree Neither Agree or Disagree Agree Strongly Agree Receptionists were friendly and helpful Receptionists were friendly and helpful Strongly Disagree Receptionists were friendly and helpful Disagree Receptionists were friendly and helpful Neither Agree or Disagree Receptionists were friendly and helpful Agree Receptionists were friendly and helpful Strongly Agree Received appointment at desired time Received appointment at desired time Strongly Disagree Received appointment at desired time Disagree Received appointment at desired time Neither Agree or Disagree Received appointment at desired time Agree Received appointment at desired time Strongly Agree Return on non-emergency phone calls was prompt (within 24 hours) Return on non-emergency phone calls was prompt (within 24 hours) Strongly Disagree Return on non-emergency phone calls was prompt (within 24 hours) Disagree Return on non-emergency phone calls was prompt (within 24 hours) Neither Agree or Disagree Return on non-emergency phone calls was prompt (within 24 hours) Agree Return on non-emergency phone calls was prompt (within 24 hours) Strongly Agree Saw provider of your choice Saw provider of your choice Strongly Disagree Saw provider of your choice Disagree Saw provider of your choice Neither Agree or Disagree Saw provider of your choice Agree Saw provider of your choice Strongly Agree Showed concern for your and your child's privacy Showed concern for your and your child's privacy Strongly Disagree Showed concern for your and your child's privacy Disagree Showed concern for your and your child's privacy Neither Agree or Disagree Showed concern for your and your child's privacy Agree Showed concern for your and your child's privacy Strongly Agree Question Title * Waiting Strongly Disagree Disagree Neither Agree or Disagree Agree Strongly Agree Time in waiting room was less than 30 minutes Time in waiting room was less than 30 minutes Strongly Disagree Time in waiting room was less than 30 minutes Disagree Time in waiting room was less than 30 minutes Neither Agree or Disagree Time in waiting room was less than 30 minutes Agree Time in waiting room was less than 30 minutes Strongly Agree Time in exam room was less than 30 minutes Time in exam room was less than 30 minutes Strongly Disagree Time in exam room was less than 30 minutes Disagree Time in exam room was less than 30 minutes Neither Agree or Disagree Time in exam room was less than 30 minutes Agree Time in exam room was less than 30 minutes Strongly Agree Time waiting for test results was appropriate Time waiting for test results was appropriate Strongly Disagree Time waiting for test results was appropriate Disagree Time waiting for test results was appropriate Neither Agree or Disagree Time waiting for test results was appropriate Agree Time waiting for test results was appropriate Strongly Agree Question Title * Facility Strongly Disagree Disagree Neither Agree or Disagree Agree Strongly Agree Office was neat and clean Office was neat and clean Strongly Disagree Office was neat and clean Disagree Office was neat and clean Neither Agree or Disagree Office was neat and clean Agree Office was neat and clean Strongly Agree It was easy to find where to go It was easy to find where to go Strongly Disagree It was easy to find where to go Disagree It was easy to find where to go Neither Agree or Disagree It was easy to find where to go Agree It was easy to find where to go Strongly Agree My child and I were comfortable while waiting My child and I were comfortable while waiting Strongly Disagree My child and I were comfortable while waiting Disagree My child and I were comfortable while waiting Neither Agree or Disagree My child and I were comfortable while waiting Agree My child and I were comfortable while waiting Strongly Agree Question Title * How likely would to be to recommend this office to family and friends Extremely Unlikely1 2 3 4 Extremely Likely5 Extremely Unlikely1 2 3 4 Extremely Likely5 Question Title * What did you like the most? Question Title * What can we do to improve? Question Title * What is yours child's full name? (Optional) Question Title * If you would like a call, please provide your phone number: Question Title * Where did you hear about us? Done
