Patient Satisfaction Survey

Concerning Your Last Appointment

We at Alliance Pediatrics want to give you the best possible medical care! To do that, we need your feedback. Please let us know what you think we’re doing right, and how we can improve, by filling out a patient survey. All of your responses will be kept strictly confidential, and your signature is not required. So please use this opportunity to respond freely.

Question Title

* 1. Please answer accordingly:

	Strongly Agree	Agree	Neither Agree or Disagree	Disagree	Strongly Disagree
Appointments are available within a reasonable amount of time.	Appointments are available within a reasonable amount of time. Strongly Agree	Appointments are available within a reasonable amount of time. Agree	Appointments are available within a reasonable amount of time. Neither Agree or Disagree	Appointments are available within a reasonable amount of time. Disagree	Appointments are available within a reasonable amount of time. Strongly Disagree
Scheduling an appointment is efficient and convenient.	Scheduling an appointment is efficient and convenient. Strongly Agree	Scheduling an appointment is efficient and convenient. Agree	Scheduling an appointment is efficient and convenient. Neither Agree or Disagree	Scheduling an appointment is efficient and convenient. Disagree	Scheduling an appointment is efficient and convenient. Strongly Disagree
The person who took my call was courteous & professional.	The person who took my call was courteous & professional. Strongly Agree	The person who took my call was courteous & professional. Agree	The person who took my call was courteous & professional. Neither Agree or Disagree	The person who took my call was courteous & professional. Disagree	The person who took my call was courteous & professional. Strongly Disagree
When I leave a message, it is returned promptly.	When I leave a message, it is returned promptly. Strongly Agree	When I leave a message, it is returned promptly. Agree	When I leave a message, it is returned promptly. Neither Agree or Disagree	When I leave a message, it is returned promptly. Disagree	When I leave a message, it is returned promptly. Strongly Disagree

Question Title

* 2. What Provider did you see at your last appointment?

Kathy Sarantos, M.D.

Michelle Massias, M.D.

Olga Mas, M.D.

Stephanie Kirkconnell, M.D.

Beth Severance, A.R.N.P.

Ginny Shreve, A.R.N.P.

Question Title

* 3. How long

	Less than 10 minutes	10-20 minutes	20-30 minutes	Greater than 30 minutes
did you wait to be taken back by a nurse once you signed in?	did you wait to be taken back by a nurse once you signed in? Less than 10 minutes	did you wait to be taken back by a nurse once you signed in? 10-20 minutes	did you wait to be taken back by a nurse once you signed in? 20-30 minutes	did you wait to be taken back by a nurse once you signed in? Greater than 30 minutes
did you wait in an exam room before seeing the provider?	did you wait in an exam room before seeing the provider? Less than 10 minutes	did you wait in an exam room before seeing the provider? 10-20 minutes	did you wait in an exam room before seeing the provider? 20-30 minutes	did you wait in an exam room before seeing the provider? Greater than 30 minutes