Rate Us

Which location did you visit? * --required
Brier Creek
Clayton
Knightdale
New Hope Commons
North Raleigh
Wake Forest
Zebulon

How would you rate our concern for your child's privacy? * --required
Outstanding
Good
Adequate
Needs Improvement
Poor
N/A

How often have you visited Growing Child Pediatrics within the past year? * --required
First Visit
2-5 Visit
More than 6

Scheduling Your Appointment:

Did you schedule an appointment by phone or did you drop in? * --required
Scheduled by Phone
Dropped In

If you scheduled an appointment, did you have to wait longer than expected to get scheduled? * --required
Yes
No

How easy was it to make an appointment by telephone? * --required
Very Easy
Easy
Somewhat Easy
Average
Somewhat Difficult
Difficult
Very Difficult

Was the person who scheduled your appointment courteous and helpful? * --required
Very Courteous
Courteous
Average
Rude
Very Rude

If you were seeking a referral to a specialist, was your request handled in a timely manner? * --required
Yes
No

How would you rate the courtesy of the staff at the reception desk? * --required
Very Courteous
Courteous
Somewhat Courteous
Average
Somewhat Rude
Rude
Very Rude

How long did you wait in the reception area beyond your scheduled appointment time? * --required
0 to 5 minutes
5 to 20 minutes
20 to 40 minutes
Other

How long did you wait in the exam room before the physician appeared? * --required
0 to 5 minutes
5 to 20 minutes
20 to 40 minutes
Other

The Nursing Staff:

How would you rate the competence of the nurse who helped you? * --required
Outstanding
Good
Adequate
Needs Improvement
Poor
N/A

How would you characterize the concern that the nurse showed for your problems? * --required
Outstanding
Good
Adequate
Needs Improvement
Poor
N/A

The Doctor:

Were you able to see the doctor of your choice? * --required
Yes
No
N/A

Did you feel that your doctor spent an adequate amount of time with you? * --required
Yes
No
N/A

Mark the boxes that characterized the demeanor of your doctor? * --required
Attentive
Concerned
Friendly
Distracted
Rushed
Inconsiderate

How would you rate the competence of your doctor? * --required
Outstanding
Good
Adequate
Needs Improvement
Poor
N/A

Did you feel your doctor's examination was thorough? * --required
Yes
No
N/A

Please rate the clarity of the doctor's explanation of your condition and treatment options: * --required
Outstanding
Good
Adequate
Needs Improvement
Poor
N/A

How well did your doctor include you in healthcare decisions? * --required
Outstanding
Good
Adequate
Needs Improvement
Poor
N/A

Were your questions answered to your satisfaction? * --required
Yes
No
N/A

Would you recommend this facility and its staff to your family and friends? * --required
Yes
No
N/A

Please list any areas in which our services could be improved

Providing the following information is optional.

First Name:

Last Name:

Your e-mail address:

Address:

City:

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ZIP:

Telephone:

Gender:
Female
Male

Age:

Would you like someone to contact you regarding your responses on this survey?
Yes
No

Thank you for taking the time to fill out our survey.

We rely on your feedback to help us improve our services. Your input is greatly appreciated.