Patient Survey
By completing this survey, you are giving consent for CARES Foundation to review your responses for the purposes of continuing evaluation of the CARES Foundation-designated center. This information will not be shared with anyone outside of this Center or CARES Foundation.
Please select Center where you received care *
Children's Hospital Los Angeles/USC/Cedars Sinai
Cook Children's Health Care System
Cohen Children's Medical Center at Northwell Health
New York-Presbyterian/Weill Cornell Medical Center
Riley Hospital for Children at Indiana University Health
Rutgers-RWJMS, Child Health Center of New Jersey
Seattle Children's Hospital/University of Washington
UT Southwestern Medical Center/Children's Medical Center Dallas
Patient Information
Gender *
Female
Male
Other
CAH Type *
Non-Classical CAH
Classical CAH
Unknown
Other
Age *
Infant (under 1 year)
Child (1-18 years)
Adult (over 18 years)
State you live in: *
Did you visit as a *
New patient
Existing patient
Date of your first consult *
Was your visit related to a surgical procedure? *
Yes
No
Which doctor did you see at this visit? *
Pediatric Endocrinologist
Adult Endocrinologist
Reproductive Endocrinologist
Other
Care Coordination
/Transition of Care
Do you know who the Care Coordinator (clinic coordinator/patient care assistant) is? *
Yes
No
Do you know how to contact the care coordinator? *
Yes
No
How long does it take to have your phone calls or emails returned by the care coordinator/nurse/physician? *
Has the care coordinator provided you with information on making appointments with other specialists/services? *
Yes
No
If "yes", what type of specialists?
Has the Center provided your primary care physician with a summary of your consultation? *
Yes
No
I do not know
Are you promptly informed of test results? *
Yes
No
Have you been informed about what specialists and services are available to you? *
Yes
No
Have you been told that you need to see other specialists? *
Yes
No
If "yes", did the care coordinator make the appointment for you? *
Yes
No
Has your psychological health been evaluated by a psychiatrist or psychologist? *
Yes
No
Advocacy
Do you think you could respond effectively:
Teaching and Training
Environment
Is the facility clean? *
Yes
No
Were you able to find the office easily? *
Yes
No
How long did you wait for the doctor? *
Do you feel you had adequate time with the doctor? *
Yes
No
Were all your questions/concerns answered and/or addressed? *
Yes
No
If no, what are they?
Speaking generally, how satisfied were you with your experience(s) at the Comprehensive Care Center? What has been going well? What would you like to see improved? *
Future Needs
Please explain:
If yes, please provide the following information:
If you have not joined CARES, we would love to have you as a part of our community. You receive information on the latest in CAH research, medication recalls, conferences, support activities and more. Go to www.caresfoundation.org and click on JOIN OUR COMMUNITY!
Thank you for participating!