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Patient Satisfaction Survey

We would like to hear about your visit with us. Please take a few minutes to answer the questions below. Be honest! You do not need to sign this survey.

Your child is:
Age (years):
Insurance:
Today you saw:



  5-Great     4-Good     3-OK     2-Fair     1-Poor
Getting through to the office by phone
Telephone calls are answered courteously
Ease of getting an appointment
After hours calls are answered promptly
Time spent in waiting room
Time in exam room before being seen by doctor
You are listened to and treated with respect
Your doctor explains information so you can understand
You get answers to your questions and concerns
You are included in decisions about your child's care
Staff keeps you informed about tests and referrals
Are you aware that we have mental health counseling currently available onsite?
Would you be comforable receiving mental health counseling in our office?
Did your provider address any mental health needs today?

Please rate any of the community services listed below that you have used (optional):

  5-Great     4-Good     3-OK     2-Fair     1-Poor
Stanly County Partnership for Children
Lactatioin Classes (SCHD)
Pregnancy Resource Center
WIC
Are there any other community resources you have used?


If the form does not submit, you are missing required information.

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