Prosthetic · Orthotic Care Centers

Patient Satisfaction Form

Were you treated in a courteous, friendly, and professional manner by our administrative staff?: Yes No
Were you treated in a courteous, friendly, and professional manner by our practitioner?: Yes No
Did your practitioner meet with you in a prompt and timely manner?: Yes No
Did your practitioner spend enough time with you?: Yes No
Were the offices and treatment areas clean and comfortable?: Yes No
Did your practitioner explain matters clearly and completely, and take sufficient time to answer all of your questions?: Yes No
Did you receive detailed and understandable instructions on how to use, clean, and care for your device?: Yes No
Did you find your practitioner knowledgeable and skillful?: Yes No
Were you shown how to correctly put on and take off your prosthetic or orthotic device?: Yes No
Did you receive your device within a reasonable period of time after your initial fitting?: Yes No
Are you pleased with the comfort, quality, function, and fit of your device?: Yes No
Were you encouraged by your practitioner to immediately contact us if you have any problems or complications with your device?: Yes No
Did the staff discuss our billing and payment policy during your first visit?: Yes No
Did our staff discuss the product warranty with you?: Yes No
Were you satisfied overall with the practice?: Yes No