Patient Feedback

In our effort to always improve the quality of our services, we would like to know about your recent experience at The Children's Medical Center. This form must be completed by the parent/guardian or patient over the age of 18. The information gathered in this form will only be used for quality improvement purposes.

Date of Visit?*
Patient's Name*
First Last
Which CMC office did you visit?*
- Greenville
- Greer
- Powdersville
- Simpsonville
Which doctor did your child see?*
Your experience before your visit...
Please rate the following.
Ease in getting through to us by phone*
Excellent Good Poor Does Not Apply
Courtesy of staff*
Excellent Good Poor Does Not Apply
Convenience of office hours*
Excellent Good Poor Does Not Apply
Ease in seeing the doctor of your choice*
Excellent Good Poor Does Not Apply
Ease in seeing the doctor of your choice*
Excellent Good Poor Does Not Apply
Ease of use of our website*
Excellent Good Poor Does Not Apply
Ease of use of our Patient Portal*
Excellent Good Poor Does Not Apply
Your experience during your visit...
Please rate the following.
Ease in locating our office*
Excellent Good Poor Does Not Apply
Courtesy of Patient Service staff*
Excellent Good Poor Does Not Apply
Courtesy of nursing staff*
Excellent Good Poor Does Not Apply
Cleanliness of waiting areas/exam rooms*
Excellent Good Poor Does Not Apply
Waiting time*
Excellent Good Poor Does Not Apply
Amount of time doctor spent with you*
Excellent Good Poor Does Not Apply
Doctor's explanation of your child's illness/treatment*
Excellent Good Poor Does Not Apply
Doctor's personal manner (courtesy, respect, sensitivity)*
Excellent Good Poor Does Not Apply
Doctor's instructions regarding medications & follow-up*
Excellent Good Poor Does Not Apply
Overall quality of care your child received*
Excellent Good Poor Does Not Apply
Was your child given enough privacy?*
Excellent Good Poor Does Not Apply
Likelihood that you would recommend us to a friend or relative?*
Excellent Good Poor Does Not Apply
Do you have any suggestions to help us improve your next experience with Children's Medical Center?
Name*
Email*

Please include your name and email address so that we may contact you to learn more about your experience. Your responses will only be used for quality improvement purposes.

Your experience before your visit...

Your experience during your visit...