Office Visit Feedback Form

Please take the time to fill out our feedback form. We use this information in an effort monitor and continually improve our services.

Ease of Making Your Appointment1 Star2 Stars3 Stars4 Stars5 Stars

Waiting Time at Reception Area1 Star2 Stars3 Stars4 Stars5 Stars

Friendliness and Courtesy of Staff1 Star2 Stars3 Stars4 Stars5 Stars

Diagnosis and Treatment Provided by Your Physician1 Star2 Stars3 Stars4 Stars5 Stars

Health Information Provided to You1 Star2 Stars3 Stars4 Stars5 Stars

Hours of Operation Convenient for You1 Star2 Stars3 Stars4 Stars5 Stars

Overall Cleanliness and Comfort1 Star2 Stars3 Stars4 Stars5 Stars

Overall Satisfaction1 Star2 Stars3 Stars4 Stars5 Stars

Please don’t include medical or health details in this form — it isn’t a secure channel for that.

Additional Comments

Apple a Day Pediatrics

Our Location

84 TEMPLETON DRIVE, SUITE 106 OSWEGO, ILLINOIS 60543 PHONE: 630-554-7654 FAX : 630-554-9258

Book Appointment Online For existing patients