Comments on Pediatric Wizards
Please take the time and let us know how we are doing by filling out the comment form below.
| Date of Visit |
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| How long have you been a parent/patient at this practice? |
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| How satisfied are you with the following? |
| Visit Overall |
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| Availability of appointment |
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| Scheduling of appointment |
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| Appearance of office |
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| Wait time in office |
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| Time with pediatrician |
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| Front office staff friendly and courteous |
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| Medical Assistant(s) sympathetic and concerned |
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| Pediatrician answered all your questions |
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| Billing procedures |
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| What specifically can we do to make your next visit better? |
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| Did we do anything in particular that enhanced your visit? (Please include names of any employees so they can be thanked personally. |
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| If you have any comments or questions you would like to share regarding your visit with us, please list them below. |
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| Name (optional) |
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| Phone Number (optional) |
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| Would you like someone to call you about your visit? |
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