We, at Pediatrics West, want to provide the best possible care to our patients. In order to help us achieve this, please fill out the following questionnaire.

1. Excellent
2. Good
3. Adequate
4. Poor

Please indicate your selection by clicking the appropriate response.

What town do you live in?

What health insurance do you have?

Did you have to wait long when scheduling this appointment?



Are you usually seen on time?

Are you satisfied with the telephone service during office hours?

Physician Care?

Nurse Practitioner Care?

Nursing Care?

In general are you satisfied with the care you receive at PEDIATRICS WEST?

Are you satisfied with AFTER HOURS ACCESS?

What can we do to IMPROVE our service to you?

What do you LIKE best about Pediatrics West?

Thank you for your cooperation. It is very important for us to know how you feel about pediatrics west so we can plan for a better future.