• CAHPS Clinician & Group Survey version 3.0 (Child)

  • Please do not answer for any other children.

  • Your Child’s Provider

  • Our records show that your child got care from the provider named below in the last 6 months.

    Name of provider label goes here

  • The questions in this survey will refer to the provider named in Question 1 as “this provider.” Please think of that person as you answer the survey.

  • Your Child’s Care From This Provider in the Last 6 Months

    These questions ask about your child’s healthcare. Do not include care your child got whenhe or she stayed overnight in a hospital. Do notinclude the times your child went for dental carevisits.

  • Clerks and Receptionists at This Provider’s Office

  • About Your Child and You

  • Thank you.

     

  • Should be Empty: