Complete Children's Health

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Patient Satisfaction Survey

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.

* Denotes a required form field.

Please use the following scale to rate your satisfaction with the items listed below:

1 - Very Dissatisfied
2 - Somewhat Dissatisfied
3 - Neutral
4 - Satisfied
5 - Very Satisfied

2. Please rate your satisfaction with the overall performance of the reception and scheduling staff.
3. Please rate your satisfaction with the overall performance of the nurse(s) who helped you.
4. Please rate your satisfaction with the overall performance of the provider who saw your child. (Physician, Physician's Assistant, or Nurse Practitioner)

Please keep your comments to 1,000 characters. If you would like to comment more than the limit will allow please feel free to call us or use our contact us form here. Thank you.

Please keep your comments to 1,000 characters. If you would like to comment more than the limit will allow please feel free to call us or use our contact us form here. Thank you.

8. If you would like someone from our office to contact you regarding your comments please enter your name and telephone number in these boxes and we will be in touch as soon as possible.

 

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