Pediatric Patient Satisfaction Survey - West Bloomfield Pediatrics PLLC

Dear Patient,
In an effort to continue to improve our practice, we kindly ask that you take five minutes to fill out this survey so that we know what we are doing well and where we need to improve to make your visit here the best it can be. Your responses will be kept strictly confidential. Thank you for your help.

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* 1. Please select the physician(s) you see at this practice.

Jennifer Cohen, MD

Seth H Forman, MD

Steven B Glickfield, DO

Anna G Strumba, MD

Alanna Nzoma, MD

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* 2. Has your child received care from this doctor with in the last 12 months? If you have not, do not answer any more questions. Please just select NO and then submit on the bottom of the page. Thank you.

Yes

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* 3. Is this the doctor you usually see if your child needs a checkup, has a health problem, or get sick or hurt?

Yes

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* 4. How long have you been going to this doctor?

Less than 6 months

At least 6 months but less than 1 year

At least 1 year but less than 3 years

At least 3 years but less than five years

Five years or more

The following questions ask about your child's healthcare. Do NOT include care your child got when he or she stayed overnight in a hospital. Do NOT include the times you went for dental visits.

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* 5. In the last 12 months, how many times did your child visit this doctor to get care?

None

Once

Twice

Three to five visits

Five to nine visits

10 or more times

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* 6. In the last 12 months, did you ever stay in the exam room with your child during a visit to this doctor?

Yes

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* 7. Did this doctor give you enough information about what was discussed during the visit when you were not there?

Yes

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* 8. Is your child able to talk with the doctor about his or her health care?

Yes

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* 9. In the last 12 months, how often did this doctor explain things in a way that was easy for your child to understand?

Never

Sometimes

Usually

Always

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* 10. In the last 12 months, how often did this provider listen carefully to your child?

Never

Sometimes

Usually

Always

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* 11. Did this doctor tell you that you needed to do anything to follow up on the care your child received during the visit?

Yes

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* 12. Did this doctor give you enough information about what you needed to do to follow up on your child's care?

Yes

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* 13. In the last 12 months, did you phone this doctor's office to get an appointment for your child for an illness, injury or condition that needed care right away?

Yes

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* 14. In the last 12 months, when you phoned this doctor's office to get an appointment for care that your child needed right away, how often did you get an appointment as soon as your child needed?

Never

Sometimes

Usually

Always

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* 15. In the last 12 months, did you make any appointments for a checkup or routine care for your child with this doctor?

Yes

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* 16. In the last 12 months, when you made an appointment for a checkup or routine care for your child with this doctor, how often did you get an appointment as soon as your child needed?

Never

Sometimes

Usually

Always

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* 17. In the last 12 months, did you phone this doctor's office with a medical question about your child during regular office hours?

Yes

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* 18. In the last 12 months, when you phoned this doctor's office during regular office hours, how often did you get an answer to your medical question that same day?

Never

Sometimes

Usually

Never

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* 19. In the last 12 months, did you phone this doctor's office with a medical question about your child after regualr office hours?

Yes

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* 20. In the last 12 months, when you phoned this doctor's office after hours, how often did you get an answer to your medical questions as soon as you needed?

Never

Sometimes

Usually

Always

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* 21. Wait time includes the time spent in the waiting room and exam room. In the last 12 months, how often did your child see this doctor within 15 minutes of his or her appointment time?

Never

Sometimes

Usually

Always

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* 22. In the last 12 months, how often did this doctor explain things about your child's health that was in a way that was easy to understand?

Never

Usually

Sometimes

Always

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* 23. In the last 12 months, how often did this doctor listen carefully to you?

Never

Sometimes

Usually

Always

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* 24. In the last 12 months, did you and this doctor talk about any questions or concerns you had about your child's health?

Yes

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* 25. In the last 12 months, how often did this doctor give you easy to understand information about these health questions or concerns?

Never

Sometimes

Usually

Always

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* 26. In the last 12 months, how often did this doctor seem to know the important information about your child's medical history?

Never

Sometimes

Usually

Always

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* 27. In the last 12 months, how often did this doctor show respect for what you had to say?

Never

Sometimes

Usually

Always

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* 28. In the last 12 months, how often did this doctor spend enough time with your child?

Never

Sometimes

Usually

Always

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* 29. In the last 12 months, did this doctor order a blood test, x-ray or other test for your child?

Yes

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* 30. In the last 12 months, when this provider ordered a blood test, x-ray or other test for your child, how often did someone from this doctor's office follow up to give you those results?

Never

Sometimes

Usually

Always

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* 31. Using any number from 0-10, where 0 is the worst doctor possible and 10 is the best doctor possible, what number would you use to rate this physician?

0 worst doctor possible

10 best doctor possible

The following questions are about Clerks and Receptionists in this office.

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* 32. In the last 12 months, how often were clerks and receptionists at this doctor's office as helpful as you thought they should be?

Never

Sometimes

Usually

Always

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* 33. In the last 12 months, how often did clerks and receptionists at this doctor's office treat you with courtesy and respect?

Never

Sometimes

Usually

Always