Anonymous Feedback Form
We know your time is limited but your opinion is valuable for us. Please help us to improve ourselves by completing the feedback form below by giving not more than 2-3 minutes.
Which clinic did you visit today?
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Kalihi
Ewa Beach
How easy or difficult is it to contact and communicate with our staff or physicians (make an appointment, ask questions, request med refills, speak to the doctor)?
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Very easy
Somewhat easy
Somewhat difficult
Very difficult
How would you rate your wait time before seeing the doctor?
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Waited longer than expected
1
2
3
4
Waited a reasonable amount of time
5
1 is Waited longer than expected, 5 is Waited a reasonable amount of time
Please rate your overall experience with our front office staff (check in, forms, scheduling next appointment, referrals)
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1
2
3
4
5
Please rate your overall experience with our back office staff (vital signs, initial intake)
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1
2
3
4
5
Please rate your overall experience with your doctor today (listening to your concerns, examination of your child, administration of vaccines)
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1
2
3
4
5
Do you feel like the plan discussed at the end of your visit was clear? (suggestions on what to do next, medications, referrals, follow up visits, etc)
No, I left confused
1
2
3
4
Yes, it was clear
5
1 is No, I left confused, 5 is Yes, it was clear
Please rate your overall experience with today's visit
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1
2
3
4
5
Please rate your overall experience with Abinsay Pediatrics
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1
2
3
4
5
What areas do you enjoy about our practice?
Please share any feedback or suggestions for improvement (we want to hear them!)
Do you consent for Abinsay Pediatrics to share your ANONYMOUS feedback on our website?
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Yes
No
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