Western Wake Pediatrics

940 SE Cary Parkway,Suite 200
Cary, North Carolina 27518
Phone: (919) 859-9991
Fax: -(919) 859-6595

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. Western Wake Pediatrics, P.A. welcomes your feedback and your answers will be kept confidential. Thank you for your participation.

General Patient Information

In general, what is the quality of your health? Outstanding
Good
Some chronic issues
Poor

How would you rate our concern for your privacy? Outstanding
Good
Adequate
Needs improvement
Poor
N/A

How often have you visited Westen Wake Pediatrics, P.A. within the year? First Visit
2-5 Visits
More than 6

Scheduling Your Appointment

Did you schedule an appointment by phone or did you drop in? Scheduled by phone
Dropped in

Did you have to wait longer than expected to get scheduled? Yes
No
N/A - Dropped in

How easy was it to make an appointment by telephone? Very Easy
Somewhat Easy
Neither Easy Nor Difficult
Somewhat Difficult
Very Difficult
N/A - Dropped in

How long did you wait to speak to a scheduling staff member? 0 to 2 minutes
3 to 5 minutes
5 to 7 minutes
Longer

Was the person who scheduled your appointment courteous and helpful? Very Courteous
Somewhat Courteous
Neither Courteous nor rude
Somewhat Rude
Rude

If you were seeking a referral to a specialist, was your request handled in a timely manner? Yes
No

Day of Your Appointment

How would you rate the courtesy of the staff at the reception desk? Very Courteous
Somewhat Courteous
Neither Courteous nor rude
Somewhat Rude
Rude

How long did you wait in the reception area beyond your scheduled appointment time? 0 to 5 minutes
5 to 20 minutes
20 to 40 minutes
Longer

How long did you wait in the exam room before the physician appeared? 0 to 5 minutes
5 to 20 minutes
20 to 40 minutes
Longer

Which department(s) did you visit during your appointment? Physician
Nurse Practitioner
Walk-in Clinic

The Nursing Staff

How would you rate the competence of the nurse who helped you? Outstanding
Good
Adequate
Needs improvement
Poor
N/A

How would you characterize the concern that the nurse showed for your problem? Outstanding
Good
Adequate
Needs improvement
Poor
N/A

Did the nurse respond to your requests within a reasonable period? Yes
No

The Doctor

Were you able to see the doctor of your choice? Yes
No
N/A

Did you feel that your doctor spent an adequate amount of time on you? Yes
No
N/A

Mark the boxes that characterize the demeanor of your doctor: Attentive
Concerned
Friendly
Distracted
Rushed
Inconsiderate

How would you rate the competence of your doctor? Outstanding
Good
Adequate
Needs Improvement
Poor
N/A

Did you feel that your doctor's examination was thorough? Yes
No
N/A

How well did your doctor include you in healthcare decisions? Outstanding
Good
Adequate
Needs improvement
Poor
N/A

Were your questions answered to your satisfaction? Yes
No
N/A

Would you recommend this facility and its staff to your family and friends? Yes
No
N/A

The Lab Staff

How would you rate the professionalism and competence of the person who took your blood and worked on your lab exam? Outstanding
Good
Adequate
Needs Improvement
Poor
N/A

If you received a lab exam or test, please indicate the type(s) of lab you received: Blood test
Strep Screen
Urine
Hearing
Vision
Other

If you received a lab exam, was the service prompt, comfortable, and courteous? Outstanding
Good
Adequate
Needs improvement
Poor
N/A

Additional Feedback

Please list any areas in which our service could be improved.

Please share any additional information.

If you would like to be contacted by the office manager, please provide the following personal information:

First name
Last name
Address #1
Address #2
Telephone
Gender
Age

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