Patient Satisfaction Survey

It was easy getting through our phone lines to schedule an appointment.

I was able to make an appointment for a date and time that was reasonable and convenient for me.

The registration and waiting areas were welcoming, clean and comfortable.

WHEN CALLING FOR A SICK VISIT ONLY:

The telephone triage nurse AFTER office hours offered helpful advice and all of my questions were answered to my satisfaction.

The telephone triage nurse DURING regular office hours offered helpful advice and all of my questions were answered to my satisfaction.

Appointments:	Princeton	(609) 924-5510
	West Windsor	(609) 799-5335
	Monroe	(609) 409-5600

We are committed to ensuring that you are satisfied with the care and services you receive at our practice. Please let us know what you think about your experience with us.

Appointment Information

1.	Date of Appointment: *	MM/DD/YYYY
2.	Which office did you visit? *
3.	What was the general purpose of the visit? *
4.	Physician or Provider Seen? *

1 = No Opinion, 2 = Extremely Unsatisfied, 3 = Unsatisfied, 4 = Satisfied, 5 = Very Satisfied

The personal manner of the following staff was courteous, respectful, friendly, and compassionate. All of my questions or concerns were well addressed.

10.	Phone/Appointment Scheduling	1	2	3	4	5
11.	Registration	1	2	3	4	5
12.	Assistant who prepared my child for the examination	1	2	3	4	5
13.	Vaccine/Injection nurse	1	2	3	4	5
14.	Laboratory/Blood Drawing Staff	1	2	3	4	5
15.	Physician	1	2	3	4	5
16.	Business Office	1	2	3	4	5

The professional or technical skills of the following staff were thorough, personable and competent:

17.	Phone/Appointment Scheduling	1	2	3	4	5
18.	Registration	1	2	3	4	5
19.	Assistant who prepared my child for the examination	1	2	3	4	5
20.	Vaccine/Injection nurse	1	2	3	4	5
21.	Laboratory/Blood Drawing Staff	1	2	3	4	5
22.	Physician	1	2	3	4	5
23.	Business Office	1	2	3	4	5

Overall, I was satisfied with:

24.	The length of time I waited to get an appointment.	1	2	3	4	5
25.	The length of time I waited in the waiting room.	1	2	3	4	5
26.	The length of time I waited for the physician in the examination room.	1	2	3	4	5
27.	The length of time I waited for the laboratory.	1	2	3	4	5
28.	The length of time I waited for vaccines.	1	2	3	4	5
29.	The thoroughness of the visit and opportunity to have all of my concerns and questions addressed.	1	2	3	4	5
30.	The overall medical care my child received at Princeton Nassau Pediatrics.	1	2	3	4	5
31.	I would recommend Princeton Nassau Pediatrics to others.	yes		no

32. Please describe any exceptional experiences, either positive or negative. Include staff/Physician names whenever possible.

33. Please include any additional or general comments.

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