Thank you for choosing KIDS TIME PEDIATRICS for your after-hours pediatric care. Our goal is to provide the best possible care for your child in partnership with your primary pediatrician. We have developed this online survey to help identify our strengths and weaknesses. By completing this survey you can help us better meet your needs.


1) Which office did you use?
Stockbridge
Peachtree City / Fayetteville
Sandy Springs
Alpharetta
East Cobb
Lawrenceville / Snellville


2) What day of the week did you visit?
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday


3) Have you been to a Kids Time office before?
Yes
No

4) What was the medical problem that caused you to visit our office?


5) Why did you decide to come to Kids Time? (check as many boxes as necessary)
My doctor told me to come.
I didn’t think I could/should wait.
I did not want to wait in an ER.
I wanted to be seen by a pediatrician.
Other reason
Please Specify:

6) If you had not come to Kids Time you would have...?
waited to see my pediatrician when he/she was next available.
visited another doctor.
visited a Urgent Care clinic.
visited an Emergency Room.
visited a non-MD office/clinic.
Other reason
Please Specify:

7) How long did you wait before you were seen by a doctor?
10 minutes
15 minutes
20 minutes
25 minutes
greater than 25 minutes


8) How satisfied were you with the amount of time you had to wait before being seen by a doctor?
Very Satisfied
Somewhat Satisfied
Undecided / N/A
Somewhat Dissatisfied
Very Dissatisfied


9) How satisfied were you with the doctor?
Very Satisfied
Somewhat Satisfied
Undecided / N/A
Somewhat Dissatisfied
Very Dissatisfied


10)   How satisfied were you with the level of attention given to your child by the doctor?
Very Satisfied
Somewhat Satisfied
Undecided / N/A
Somewhat Dissatisfied
Very Dissatisfied


11) How satisfied were you with the courtesy you were shown by staff at the office?
Very Satisfied
Somewhat Satisfied
Undecided / N/A
Somewhat Dissatisfied
Very Dissatisfied


12) Overall, how would you rate your visit to our office?
Very Positive
Somewhat Positive
Undecided / N/A
Somewhat Negative
Very Negative


13) What did you like most about your visit to our office?


14) What did you like least about your visit to our office?


15) What can we do to make future visits better for you and your child?


16) Would you like to be contacted by a member of Management?
Yes
No

17) Your Contact Information