Appointments: 540-347-9900
20 Rock Pointe, Warrenton, VA 20186

Piedmont Pediatrics Feedback Form

How Are We Doing?

Please take a few minutes to fill out this survey on the timeliness and quality of the service you received today. Piedmont Pediatrics welcomes your feedback and your answers will be kept confidential. Thank you for your participation.

General Patient Information
Your appointment today was for:
How would you rate our concern for your child’s health?:
How often have you visited Piedmont Pediatrics within the past year?:
Scheduling Your Appointment
Did you speak with a nurse or a receptionist to schedule your appointment?:
Were you able to get an appointment at a reasonable date and time?:
How easy was it to make an appointment by telephone?:
How long did you wait to speak to a scheduling staff member?:
Was the person who scheduled your appointment courteous and helpful?:
If you were seeking a referral to a specialist, was your request handled in a timely manner?:
Day of Your Appointment
How would you rate the courtesy of the staff at the reception desk?:
How long did you wait in the reception area beyond your scheduled appointment time?:
How long did you wait in the exam room before the physician appeared?:
Which Provider did you see for this appointment?:
The Nursing Staff
How would you rate the competence of the nurse who helped you?:
How would characterize the concern that the nurse showed for your problem?:
Was the demeanor of the nurse friendly and helpful?:
The Doctor
Were you able to see the doctor of your choice?:
Did you feel that your doctor spent an adequate amount of time with you?:
Mark the boxes that characterize the demeanor of your doctor:
How would you rate the competence of your doctor?:
Did you feel that your doctor’s examination was thorough?:
Please rate the clarity of the doctor’s explanation of your condition and treatment options:
How well did your doctor include you in healthcare decisions?:
Were your questions answered to your satisfaction?:
Would you recommend this facility and its staff to your family and friends?:
The Lab Staff
How would you rate the professionalism and competence of the person who took your child’s blood and worked on your lab exam?:
If your child had a lab exam, was the service prompt, comfortable, and courteous?:
Additional Feedback
Personal Information
Would you like someone to contact you regarding your responses on this survey?:
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