Dear Parents –
We value your opinion, and continually look for ways to improve our services. We would appreciate your feedback regarding the quality of attention given to your family. Please take a few moments to complete our survey and let us know how we are doing.

 
Date of last appointment or phone call?  
 
Which provider did you see?
Dr UniteDr AddyDr ChangDr Travis Kristie Jen
 
How courteous was the person who answered your call
 Excellent
 Good
 Unsatisfactory
 Not Applicable
 
Comments:

Was your call answered in a prompt and timely manner?
 Yes
 No
 Not Applicable
 
Comments:

Was your call placed on hold? If so, was the wait long?
 No waiting
 2 to 5 minutes
 over 5 minutes
 Not Applicable
 
Comments:

Please rate the availability and timeliness of appointment scheduling.
 Excellent
 Good
 Unsatisfactory
 Not Applicable
 
Comments:

Was there an available appointment with your doctor?
 Yes
 No
 Not Applicable
 
Comments:

Were you greeted by the receptionist in a friendly and courteous manner?
 Yes
 No
 Not Applicable
 
Comments:

Please rate the general knowledge and competence of the reception staff.
 Excellent
 Good
 Unsatisfactory
 Not Applicable
 
Comments:

At the completion of your visit, were you given an opportunity to schedule another appointment?
 Yes
 No
 Not Applicable
 
Comments:

 
Was the call returned in a prompt and timely manner?
 Yes
 No
 Not Applicable
 
Comments:

Please rate the general knowledge and competence of our triage staff.
 Excellent
 Good
 Unsatisfactory
 Not Applicable
 
Comments:

As an additional resource tool, did you refer to our Symptom Checker on the website?
 Yes
 No
 Not Applicable
 
Comments:

 
Did your appointment begin promptly?
 Yes
 No
 over 15 minutes
 Not Applicable
 
Comments:

Was the medical assistant attentive to your concerns or questions?
 Yes
 No
 Not Applicable
 
Comments:

Did the medical assistant seem genuinely friendly to your child?
 Yes
 No
 Not Applicable
 
Comments:

Were you provided with handouts or immunization records?
 Yes
 No
 Not Applicable
 
Comments:

Please rate the explanations or instructions the provider gave you about your symptoms and follow-up care
 Excellent
 Good
 Unsatisfactory
 Not Applicable
 
Comments:

 
Were our waiting rooms, exam rooms and bathrooms clean?
 Yes
 No
 Not Applicable
 
Comments:

Do the hours of operation meet all the needs for your schedule?
 Yes
 No
 Not Applicable
 
Comments:

Would you recommend this clinic to others?
 Yes
 No
 Not Applicable
 
Comments:

While visiting, was there anyone who made your visit stand out?
 Yes
 No
 Not Applicable
 
Comments:

Do you find our website helpful and infromative
 Yes
 No
 Not Applicable
 
Comments:

You are the key to our success, and we strive to do our best because of you!