Tampa PediatriciansSt. Petersburg Pediatricians
Sep. 08, 2010













For more information about your child's health, be sure to visit our two affiliated award-winning sites, KidsGrowth, and TeenGrowth- click on the logos below. Our pediatricians contribute to the production of these resources.
Search Kidsgrowth:

Search TeenGrowth:

Comment Card

Nothing is more important to us than your satisfaction. Our pediatricians and office staff are here to help you. Please help us continue to grow by commenting on your recent visit. All personally identifiable information will be kept strictly confidential.

**Please Note: This form is for the purpose of providing general feedback regarding your satisfaction with an office visit. If you need to provide or request specific health information regarding your child, you need to call your pediatrician's office directly. The comment card is not a tool to communicate directly with your pediatrician.**

Date of Visit (month date, year)     
Pediatrician/Nurse Practitioner who saw your child?     
Which office did you visit?     
How long have you been a parent/patient at this practice?     
How satisfied are you with the following?  
Visit Overall     
Availability of appointment     
Scheduling of appointment     
Scheduled with your choice of pediatrician/ARNP     
Appearance of office     
Wait time in office     
Time with pediatrician/ARNP     
Front office staff friendly and courteous     
Nurses sympathetic and concerned     
Pediatrician/ARNP answered all your questions     
Billing procedures     
What specifically can we do to make your next visit better?     
Did we do anything in particular that enhanced your visit? (Please include names of any employees so they can be thanked personally.     
If you have any comments or questions you would like to share regarding your visit with us, please list them below.     
Name (optional)     
Phone Number (optional)     
Would you like someone to call you about your visit?     
    


HIPAA Privacy Notice
About Us | Our Services | Locations/Office Hours | Insurances We Accept
Copyright © 2001-2010 Pediatric Health Alliance, LLC

Web Design by Gecko Media
KidsGrowth.com
Teengrowth.com