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?