Merchant Pediatrics Survey

Merchant Pediatrics Survey

Here at Merchant Pediatrics, we are always striving to provide a positive patient experience. You can help us continue to improve by participating in this short survey. Please check the box next to your answer.

Your Privacy is Protected. Do not write your name or your child’s name on this survey. Your responses to this survey are also completely confidential.

Your Participation is Voluntary. You may choose to answer this survey or not. If you choose not to, this will not affect the health care you get.

These questions ask about your child’s care by this provider. Do not include care your child got when he or she stayed overnight in a hospital. Do not include the times your child went for dental care visits.

In the last 12 months, how many times did your child visit this provider for care?*
1 time2 to 45 to 910 or more times
In the last 12 months, when you phoned this provider’s office to get an appointment for care your child needed right away, how often did you get an appointment as soon as your child needed?*
NeverSometimesUsuallyAlways
In the last 12 months, how many days did you usually have to wait for an appointment when your child needed care right away?*
Same day1 day2 to 3 days4 to 7 daysMore than 7 days
In the last 12 months, when you made an appointment for a check-up or routine care for your child with this provider, how often did you get an appointment as soon as your child needed?*
NeverSometimesUsuallyAlways
Did this provider’s office give you information about what to do if your child needed care during evenings, weekends, or holidays? *
YesNo
In the last 12 months, when you phoned this provider’s office during regular office hours, how often did you get an answer to your medical question that same day?*
NeverSometimesUsuallyAlwaysNot applicable

In the last 12 months, when you phoned this provider’s office after regular office hours, how often did you get an answer to your medical question as soon as you needed?*
NeverSometimesUsuallyAlwaysNot applicable
In the last 12 months, did you get any reminders about your child’s care from this provider’s office between visits? *
YesNo
In the last 12 months, how often did this provider explain things about your child’s health in a way that was easy to understand?*
NeverSometimesUsuallyAlways
In the last 12 months, how often did the provider seem informed and up-to-date about the care your child got from specialists? *
NeverSometimesUsuallyAlways
In the last 12 months, did you and anyone in this provider’s office talk about the kinds of behaviors that are normal for your child at this age? *
YesNo
In the last 12 months, did you and anyone in this provider’s office talk about how your child’s body is growing? *
YesNo
In the last 12 months, did you and anyone in this provider’s office talk about your child’s moods and emotions? *
YesNo
In the last 12 months, did you and anyone in this provider’s office talk about how much time your child spends on a computer and in front of a TV?*
YesNo
In the last 12 months, did you and anyone in this provider’s office talk about how much or what kind of food your child eats? *
YesNo
In the last 12 months, did you and anyone in this provider’s office talk about how much or what kind of exercise your child gets?*
YesNo
In the last 12 months, did anyone in this provider’s office talk with you about specific goals for your child’s health?*
YesNo
In the last 12 months, did anyone in this provider’s office ask you if there are things that make it hard for you to take care of your child’s health? *
YesNo
What is your child’s age?*
Less than 1 year old

Is your child of Hispanic or Latino origin or descent?*
Yes, Hispanic or LatinoNo, not Hispanic or Latino
What is your child’s race? Mark one or more.*

WhiteBlack or African AmericanAsianNative Hawaiian or Other Pacific IslanderAmerican Indian or Alaska NativeOther

Latest News & Announcements

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