Our Offices
South Jordan
1268 W. South Jordan Parkway, Suite 201
South Jordan, UT 84095
801-254-9700 		  Herriman
13242 S. 5600 W.
Herriman, UT 84065
801-987-8541

Patient Satisfaction Survey

Share Your Experience







Your satisfaction is very important. Please let us know about your experience with us.

1. Which provider did you see today?
 
On a scale from 1 to 5
( With 0 = Not Applicable / No Answer, 1 = Extremely Dissatisfied, and 5 = Extremely Satisfied )
Please rate the following:
 
2. Length of time it took to get an appointment 0 1 2 3 4 5
3. Length of time spent in the waiting room 0 1 2 3 4 5
4. Length of time spent in the exam room waiting to be seen 0 1 2 3 4 5
5. Physical environment of the office 0 1 2 3 4 5
6. Friendliness and helpfulness of office staff 0 1 2 3 4 5
7. Friendliness and helpfulness of nursing staff 0 1 2 3 4 5
8. Friendliness and helpfulness of billing staff 0 1 2 3 4 5
9. Satisfaction with the results of your care 0 1 2 3 4 5
10. Overall satisfaction with Families First Pediatrics 0 1 2 3 4 5
11. Have you visited/used our website prior to today? N/A Yes No
 
If yes, on a scale from 1 to 5
( With 0 = Not Applicable / No Answer, 1 = Extremely Dissatisfied, and 5 = Extremely Satisfied )
Please rate the following:
 
12. How useful did you find the content/information provided? 0 1 2 3 4 5
Any additional comments?