Patient Satisfaction Survey

We are committed to ensuring that you are satisfied with the care and services you receive at our practice. Please let us know what you think about your experience with us.

Appointment Information
1. Date of your appointment: * MM/DD/YYYY
2. Which office location did you visit? *
3. Physician or Provider Seen? *

 

1 = No Opinion, 2 = Extremely Unsatisfied, 3 = Unsatisfied, 4 = Satisfied, 5 = Very Satisfied

4.

It was easy getting through our phone lines to schedule an appointment.

1

2

3

4

5

5.

I was able to make an appointment for a date and time that was reasonable and convenient to me.

1

2

3

4

5

6.

The registration and waiting areas were welcoming, clean and comfortable.

1

2

3

4

5

7.

I was encouraged to ask questions and all of my questions were answered to my satisfaction.

1

2

3

4

5

 

The professional or technical skill of the following staff were thorough, personable and competent; respectful, friendly and compassionate. All of my questions or concerns were well addressed:

8.

Phone/Appointment Scheduling

1

2

3

4

5

9.

Registration

1

2

3

4

5

10.

Clinical Staff

1

2

3

4

5

11.

Provider (doctor)

1

2

3

4

5

12.

Office and Billing

1

2

3

4

5

 

Overall, I was satisfied with:

13.

The length of time I waited to get an appointment.

1

2

3

4

5

14.

The length of time I waited to be seen by a provider.

1

2

3

4

5

15.

The total length of time it took for my appointment.

1

2

3

4

5

16.

The explanations of the exam, procedures, test results and/or treatments that I received.

1

2

3

4

5

17.

Would you recommend Pediatric Associates to others?

Yes

No

 

 

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