Patient Survey

We would like to know how you feel about the services we provide so we can make sure we are meeting your needs. Your responses are directly responsible for improving these services. All responses will be kept confidential and anonymous. Thank you for your time.


Please select how well you think we are doing in the following areas:

Please select which office you currently visit with your child(ren):
Patient Care
Ability to get an appointment:
Office Hours:
Prompt return on calls:
How useful do you find our patient handouts?:
Waiting
Time in waiting room:
Time in exam room:
Staff
Providers
Listens to you:
Takes enough time with you:
In the last 12 months, did your provider or someone from the office discuss with you about your personal goals (Examples: weight loss, increase exercise, healthy diet, education support, etc.):
How comfortable are you with seeing any physician in our practice?:
How would you rate the advice/guidance you are receiving from the physicians?:
Nurses
Friendly and helpful to you:
Answers your questions:
Front Desk
Friendly and helpful to you:
Answers your questions:
Forms/referrals/authorization requests are done in a timely & efficient manner:
Billing Department
Friendly and helpful to you:
Answers your questions:
Facility
Neat and clean:
Comfort and Safety while waiting:
Answering Service
Friendly and helpful to you:
Response Time:
Did you ever have to call more than once to get a response from the provider?:
Did you ever have trouble getting through to the answering service?:
Website
Have you visited our website (www.gpmpediatrics..com)?:
How useful do you find our website?:
Would you be interested in accessing your child’s medical records through our website?:
Overall
Would you recommend our practice to others?:
What is your overall rating of our practice?:
How were you referred to our office?:

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7715 4th Avenue Brooklyn, New York 11209 phone: 718.833.2300 fax: 718.836.2305
1779 Richmond Avenue Staten Island, New York 10314 phone: 718.982.6800 fax: 718.982.6830