Please send us feedback about your experience with Physicians and Staff of Metropolitan Pediatrics
Select a Clinic site


Please answer the questions on a scale of 1-5
(1=dissatisfied, 3=satisfied, 5=extremely satisfied)

  1. How satisfied are you that your phone calls are returned in a timely fashion?
    1 2 3 4 5

  2. How satisfied are you with the amount of time on hold when you call?
    1 2 3 4 5

  3. How satisfied are you with the days and times Metropolitan Pediatrics is open to schedule appointments for your children?
    1 2 3 4 5

  4. How satisfied were you with the way you were treated by the receptionist at your most recent visit?
    1 2 3 4 5

  5. How satisfied were you with the amount of time (if any) in the waiting room?
    1 2 3 4 5

  6. How satisfied were you with the way you were treated by the nursing staff at your most recent visit?
    1 2 3 4 5

  7. How satisfied were you that the doctor explained things in a way you could understand?
    1 2 3 4 5

  8. How satisfied were you with the length of time the doctor spent with your child?
    1 2 3 4 5

  9. How satisfied were you overall with your experience during the visit?
    1 2 3 4 5

  10. Would you recommend Metropolitan Pediatrics to others?
    1 2 3 4 5

Name of Physician seen on this visit

Please send us your comments or suggestions

OPTIONAL INFORMATION

Date of visit:   Month Day Year

Child's name:

May we contact you regarding your satisfaction with your visit? yesno
If so, what is the best phone number to reach you?

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