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Orthopedic Surgery

Service Satisfaction Questionnaire




Would you take a few minutes of your time to help us? Our goal is to provide comfort, convenience, and satisfaction as well as the very best medical care to all our patients. We'd like to know how you feel about our medical services, our patient-handling systems, or physicians and staff members. Your comments will help us evaluate our operations to ensure that we are truly responsive to your needs. Thank you for your help.

[FrontPage Save Results Component] Appointment available within a reasonable amount of time
excellent good adequate poor Not applicable

Appointment scheduled at a convenient time of day.
excellent good adequate poor Not applicable

Are able to get a same day appointment if you are very sick.
Excellent Good Adequate Poor Not Applicable

Waiting time in the reception area.
Excellent Good Adequate Poor Not Applicable

Staff member explained delays if any.
Excellent Good Adequate Poor Not Applicable

Waiting time in the exam room.
Excellent Good Adequate Poor Not Applicable

Staff member checked on you while you waited in exam room and explained delays if any.
Excellent Good Adequate Poor Not Applicable

The competence and kindness of our nurses and medical assistants.
Excellent Good Adequate Poor Not Applicable

The helpfulness and kindness of the people in our business office.
Excellent Good Adequate Poor Not Applicable

The professionalism of our technical staff.
Excellent Good Adequate Poor Not Applicable

Your phone calls answered promptly.
Excellent Good Adequate Poor Not Applicable

Satisfied with the way phone calls are handled.
Excellent Good Adequate Poor Not Applicable

The friendliness and courtesy of our receptionists.
Excellent Good Adequate Poor Not Applicable

Explanation of your test procedure (if applicable).
Excellent Good Adequate Poor Not Applicable

The cleanliness of the office.
Excellent Good Adequate Poor Not Applicable

Effectiveness of our health information materials.
Excellent Good Adequate Poor Not Applicable

Your Doctor:

Your Name (Optional):

How can we improve?


Any staff member that stands out about the call of duty?

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