Patient Care Survey
Dear Parent / Guardian Please take a few minutes of your time to help us. Our goal is to provide comfort, convenience and satisfaction as well as the best medical care to our patients and families. Your comments will help us to continue to improve our services
Date:
How old is your child:
Is your child:
Male
Female
Prefer not to answer
How long has your child been coming to DHPA:
less than 6 months
at least 6 months but less than 1 year
at least 1 year but less than 3 years
at least 3 years but less than 5 years
5 years or more
Which provider does your child USUALLY see:
Matthew McCarthy, MD
Despina (Penny) Soppas, MD
Asha Advani, MD
Sonia Jain,MD
Susan Uy, DO
Asmita Parajuli, MD
Raissa Anstett, MD
Hannah Sperring, CPNP
Kelly Green, CRNP
Which Provider did your child see for the MOST RECENT VISIT:
Matthew McCarthy, MD
Despina (Penny) Soppas, MD
Asha Advani, MD
Sonia Jain, MD
Susan Uy, DO
Asmita Parajuli, MD
Raissa Anstett, MD
Hannah Sperring, CPNP
Kelly Green, CRNP
What service did your child receive that has prompted you to complete this survey:
Well Child Appointment
Sick Appointment
Other
Convenience of office hours:
Please Select
Good
Fair
Poor
N/A
Other
Courtesy of the office receptionist:
Please Select
Good
Fair
Poor
N/A
Other
Courtesy of the telephone triage staff:
Please Select
Good
Fair
Poor
N/A
Other
Courtesy of the office medical staff:
Please Select
Good
Fair
Poor
N/A
Other
Waiting time to speak with phone nurse:
Please Select
Good
Fair
Poor
N/A
Other
Waiting time to see the doctor/nurse practitioner:
Please Select
Good
Fair
Poor
N/A
Other
Overall quality of care received:
Please Select
Good
Fair
Poor
N/A
Other
Instructions given regarding medications and follow-up care:
Please Select
Good
Fair
Poor
N/A
Other
Promptness of returned phone calls from doctor:
Please Select
Good
Fair
Poor
N/A
Other
Promptness of returned phone calls from nursing staff:
Please Select
Good
Fair
Poor
N/A
Other
Assistance with billing or insurance questions:
Please Select
Good
Fair
Poor
N/A
Other
Care and professionalism shown by our staff and physicians:
Please Select
Good
Fair
Poor
N/A
Other
Did the provider listen carefully to you / your child:
Please Select
1 (BEST)
2
3
4
5 (WORST)
Did the provider explain things in a way that was easy for you / your child to understand:
Please Select
1 (BEST)
2
3
4
5 (WORST)
Did the provider show respect for what you had to say:
Please Select
1 (BEST)
2
3
4
5 (WORST)
Did the provider spend enough time with your child:
Please Select
1 (BEST)
2
3
4
5 (WORST)
Overall, what number would you use to rate this provider:
Please Select
1 (BEST)
2
3
4
5 (WORST)
Overall, what number would you use to rate Drexel Hill Pediatrics:
Please Select
1 (BEST)
2
3
4
5 (WORST)
Other
Would you recommend our office to a family member or friend:
Please Select
YES
NO
MAYBE
Additional Comments: for example: What aspects do you like? How can we improve:
Optional: Your Name
Optional: Patient Name
Submit
Should be Empty: