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?* Never Sometimes Usually Always
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 day 1 day 2 to 3 days 4 to 7 days More 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?* Never Sometimes Usually Always
Did this provider’s office give you information about what to do if your child needed care during evenings, weekends, or holidays? * Yes No
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?* Never Sometimes Usually Always Not 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?* Never Sometimes Usually Always Not applicable
In the last 12 months, did you get any reminders about your child’s care from this provider’s office between visits? * Yes No
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?* Never Sometimes Usually Always
In the last 12 months, how often did the provider seem informed and up-to-date about the care your child got from specialists? * Never Sometimes Usually Always
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? * Yes No
In the last 12 months, did you and anyone in this provider’s office talk about how your child’s body is growing? * Yes No
In the last 12 months, did you and anyone in this provider’s office talk about your child’s moods and emotions? * Yes No
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?* Yes No
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? * Yes No
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?* Yes No
In the last 12 months, did anyone in this provider’s office talk with you about specific goals for your child’s health?* Yes No
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? * Yes No
What is your child’s age?* Less than 1 year old
Is your child of Hispanic or Latino origin or descent?* Yes, Hispanic or Latino No, not Hispanic or Latino
