Customer Satisfaction Survey
Dear Patient(s),
In an effort to continue to improve our practice, we kindly ask that you take five minutes to fill out this survey so we know what we are doing well and where we need to improve to make your visit here the best it can be.
Front Desk:
Were you greeted promptly and courteously? Yes No N/A Comments
Was the check-in process efficient and timely? Yes No N/A Comments
Was the check-out process efficient and timely? Yes No N/A Comments
Triage:
Was the process of calling triage easy to use and understand? Yes No N/A Comments
Was your call returned promptly and professionally? Yes No N/A Comments
How long did it take to receive a return phone call: Were your concerns addressed in a polite and professional manner? Yes No N/A Comments
Providers:
Were you seen in a timely manner? Yes No N/A Comments
Do feel that the provider has a genuine concern for your child’s well-being? Yes No N/A Comments
Office Appearance:
Do you find the front desk/waiting area to be inviting, clean, and modern looking? Yes No N/A Comments
Do you find the exam rooms to be inviting, clean, and modern looking? Yes No N/A Comments
Other Comments:
Please feel free to tell us what we can do to enhance your experience with us.
Optional: Name: Child (Children's) Name: Phone Number: May we contact you? Yes No
