Patient Satisfaction Survey

Name*

First Last

Phone*

Email*

What is your preferred method of contact?*

Appointment Information

Clinic*

Name of Provider Seen*

Your Child's Name

First Last

Appointment Date

How satisfied are you that your phone calls are returned in a timely fashion?*

How satisfied are you with the amount of time on hold when you call?*

How satisfied are you with the days and times Metropolitan Pediatrics is open to schedule appointments for your children?*

How satisfied were you with the way you were treated by the receptionist at your most recent visit?*

How satisfied were you with the amount of time in the waiting room?*

How satisfied were you with the way you were treated by the nursing staff at your most recent visit?*

How satisfied were you that the doctor explained things in a way you could understand?*

How satisfied were you with the length of time the doctor spent with your child?*

How satisfied were you overall with your experience during the visit?*

Would you recommend Metropolitan Pediatrics to others?*

Other Comments/Feedback

Can we share your comments on our website or Facebook page?*