Date of visit (month, date, year)     
Pediatrician/Nurse practitioner who saw your child?     
How long have you been a parent/patient at this practice?     
How satisfied are you with the following?  
Visit overall     
Availability of appointment     
Scheduling of appointment     
Scheduled with your choice of pediatrician/CPNP     
Appearance of office     
Wait time in office     
Time with pediatrician/CPNP     
Front office staff friendly and courteous     
Nurses sympathetic and concerned     
Pediatrician/CPNP answered all your questions     
Billing procedures     
What specifically can we do to make your next visit better?     
Did we do anything in particular that enhanced your visit? (Please include names of any employees so they can be thanked personally.     
If you have any comments or questions you would like to share regarding your visit with us, please list them below.     
Name (optional)     
Phone number (optional)     
Email (optional)     
Would you like someone to call you about your visit?     
    

If you would like to contact our Practice Manager
during regular business hours with additional questions or concerns:

Telephone : 585-225-0950

Fax : 585-225-9093

To contact our billing department: billing@longpondpeds.com
For all other inquiries, contact our Practice Mananger: providers@longpondpeds.com

The information provided on this website is not a substitute for professional care.
You should consult your own physician or other health care provider for specific advice and treatment,
which advice and treatment will be based upon your individual facts and circumstances.

 

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