Woburn & North Andover Pediatrics
Patient Experience Survey

We value your feedback!

Please think of the last visit your child had to one of our locations. Use that experience to answer the following questions. Thank you for your time.

Question Title

* 1. Please tell us which location you visited.

Woburn Office - in person

North Andover Office - in person

Virtual Visit

Question Title

* 2. Please let us know when you were seen (or your best guess)

Date

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* 3. Please let us know which provider your child saw (for which you answered these questions.)

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* 4. Access: please rate how you felt about your access to care, advice, and other assistance.

	Completely Satisfied	Satisfied	Neutral	Dissatisfied	Completely Dissatisfied	N/A
Appointment availability within a reasonable timeframe	Appointment availability within a reasonable timeframe Completely Satisfied	Appointment availability within a reasonable timeframe Satisfied	Appointment availability within a reasonable timeframe Neutral	Appointment availability within a reasonable timeframe Dissatisfied	Appointment availability within a reasonable timeframe Completely Dissatisfied	Appointment availability within a reasonable timeframe N/A
Getting advice/help during office hours	Getting advice/help during office hours Completely Satisfied	Getting advice/help during office hours Satisfied	Getting advice/help during office hours Neutral	Getting advice/help during office hours Dissatisfied	Getting advice/help during office hours Completely Dissatisfied	Getting advice/help during office hours N/A
Getting after-hours care	Getting after-hours care Completely Satisfied	Getting after-hours care Satisfied	Getting after-hours care Neutral	Getting after-hours care Dissatisfied	Getting after-hours care Completely Dissatisfied	Getting after-hours care N/A
Received appointment for urgent care in timely manner	Received appointment for urgent care in timely manner Completely Satisfied	Received appointment for urgent care in timely manner Satisfied	Received appointment for urgent care in timely manner Neutral	Received appointment for urgent care in timely manner Dissatisfied	Received appointment for urgent care in timely manner Completely Dissatisfied	Received appointment for urgent care in timely manner N/A
Received appointment for non-urgent care in timely manner	Received appointment for non-urgent care in timely manner Completely Satisfied	Received appointment for non-urgent care in timely manner Satisfied	Received appointment for non-urgent care in timely manner Neutral	Received appointment for non-urgent care in timely manner Dissatisfied	Received appointment for non-urgent care in timely manner Completely Dissatisfied	Received appointment for non-urgent care in timely manner N/A
Medical questions were answered within 24 hours	Medical questions were answered within 24 hours Completely Satisfied	Medical questions were answered within 24 hours Satisfied	Medical questions were answered within 24 hours Neutral	Medical questions were answered within 24 hours Dissatisfied	Medical questions were answered within 24 hours Completely Dissatisfied	Medical questions were answered within 24 hours N/A
Ability for office staff to assist you	Ability for office staff to assist you Completely Satisfied	Ability for office staff to assist you Satisfied	Ability for office staff to assist you Neutral	Ability for office staff to assist you Dissatisfied	Ability for office staff to assist you Completely Dissatisfied	Ability for office staff to assist you N/A

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* 5. Communication: please rate how you felt about communication with the office (both staff and providers).

	Completely Satisfied	Satisfied	Neutral	Dissatisfied	Completely Dissatisfied	N/A
Willingness to listen carefully to you/your child	Willingness to listen carefully to you/your child Completely Satisfied	Willingness to listen carefully to you/your child Satisfied	Willingness to listen carefully to you/your child Neutral	Willingness to listen carefully to you/your child Dissatisfied	Willingness to listen carefully to you/your child Completely Dissatisfied	Willingness to listen carefully to you/your child N/A
Taking time to answer your questions so that you could understand	Taking time to answer your questions so that you could understand Completely Satisfied	Taking time to answer your questions so that you could understand Satisfied	Taking time to answer your questions so that you could understand Neutral	Taking time to answer your questions so that you could understand Dissatisfied	Taking time to answer your questions so that you could understand Completely Dissatisfied	Taking time to answer your questions so that you could understand N/A
Office staff was courteous and respectful	Office staff was courteous and respectful Completely Satisfied	Office staff was courteous and respectful Satisfied	Office staff was courteous and respectful Neutral	Office staff was courteous and respectful Dissatisfied	Office staff was courteous and respectful Completely Dissatisfied	Office staff was courteous and respectful N/A

Question Title

* 6. Coordination of Care: please rate how you felt about the care you received in a team setting, including any coordinating for outside care.

	Completely Satisfied	Satisfied	Neutral	Dissatisfied	Completely Dissatisfied	N/A
The way your provider involves outside providers in your/your child's care	The way your provider involves outside providers in your/your child's care Completely Satisfied	The way your provider involves outside providers in your/your child's care Satisfied	The way your provider involves outside providers in your/your child's care Neutral	The way your provider involves outside providers in your/your child's care Dissatisfied	The way your provider involves outside providers in your/your child's care Completely Dissatisfied	The way your provider involves outside providers in your/your child's care N/A
Provider's knowledge about tests ordered outside of the office	Provider's knowledge about tests ordered outside of the office Completely Satisfied	Provider's knowledge about tests ordered outside of the office Satisfied	Provider's knowledge about tests ordered outside of the office Neutral	Provider's knowledge about tests ordered outside of the office Dissatisfied	Provider's knowledge about tests ordered outside of the office Completely Dissatisfied	Provider's knowledge about tests ordered outside of the office N/A
Provider's explanation of how best to follow your/your child's plan of care	Provider's explanation of how best to follow your/your child's plan of care Completely Satisfied	Provider's explanation of how best to follow your/your child's plan of care Satisfied	Provider's explanation of how best to follow your/your child's plan of care Neutral	Provider's explanation of how best to follow your/your child's plan of care Dissatisfied	Provider's explanation of how best to follow your/your child's plan of care Completely Dissatisfied	Provider's explanation of how best to follow your/your child's plan of care N/A
Ability of provider and/or office to assist in follow up care	Ability of provider and/or office to assist in follow up care Completely Satisfied	Ability of provider and/or office to assist in follow up care Satisfied	Ability of provider and/or office to assist in follow up care Neutral	Ability of provider and/or office to assist in follow up care Dissatisfied	Ability of provider and/or office to assist in follow up care Completely Dissatisfied	Ability of provider and/or office to assist in follow up care N/A

Question Title

* 7. Whole Person Care/Self Management: please rate how you felt about receiving overall care.

	Completely Satisfied	Satisfied	Neutral	Dissatisfied	Completely Dissatisfied	N/A
Advice given to you on ways to stay healthy	Advice given to you on ways to stay healthy Completely Satisfied	Advice given to you on ways to stay healthy Satisfied	Advice given to you on ways to stay healthy Neutral	Advice given to you on ways to stay healthy Dissatisfied	Advice given to you on ways to stay healthy Completely Dissatisfied	Advice given to you on ways to stay healthy N/A
The way you were taught about improving your/your child's health	The way you were taught about improving your/your child's health Completely Satisfied	The way you were taught about improving your/your child's health Satisfied	The way you were taught about improving your/your child's health Neutral	The way you were taught about improving your/your child's health Dissatisfied	The way you were taught about improving your/your child's health Completely Dissatisfied	The way you were taught about improving your/your child's health N/A

Question Title

* 8. How old is the patient for whom this survey is being completed?

Prenatal or Newborn Appointment

<2 years

2-12 years

13-17 years

18+ years

Question Title

* 9. Who is completing this survey?

Patient

Parent

Other legal guardian

Woburn & North Andover PediatricsPatient Experience Survey

We value your feedback!

Question Title

* 1. Please tell us which location you visited.

Question Title

* 2. Please let us know when you were seen (or your best guess)

Question Title

* 3. Please let us know which provider your child saw (for which you answered these questions.)

Question Title

* 4. Access: please rate how you felt about your access to care, advice, and other assistance.

Question Title

* 5. Communication: please rate how you felt about communication with the office (both staff and providers).

Question Title

* 6. Coordination of Care: please rate how you felt about the care you received in a team setting, including any coordinating for outside care.

Question Title

* 7. Whole Person Care/Self Management: please rate how you felt about receiving overall care.

Question Title

* 8. How old is the patient for whom this survey is being completed?

Question Title

* 9. Who is completing this survey?

Question Title

* 10. Do you have any other feedback you'd like to share?

Woburn & North Andover Pediatrics
Patient Experience Survey