Home » PATIENT SATISFACTION SURVEY PATIENT SATISFACTION SURVEY 1. Which doctor are you seeing? Dr. Milne Dr. King Dr. Doll Dr. Farley Dr. Krummenacher Dr. Bassman 2. What was the purpose of your call or visit to the office? Ask general questions Schedule an appointment Follow-up Ask for directions 3.How did you select us for your care today? Referred by my primary care physician Referred by friend or family Convenient location Insurance Please rate the following Excellent, Good, Fair, or Poor 1. Ease of scheduling appointment with your doctor. Excellent Fair Good Poor 2. Helpfulness and courtesy of staff. Excellent Fair Good Poor 3. Your information was collected in a confidential manner that maintained your privacy Excellent Fair Good Poor 4. Timeliness of being seen at your appointment time. Excellent Fair Good Poor 5. Time spent with your doctor. Excellent Fair Good Poor 6. Comfort of exam room. Excellent Fair Good Poor 7. Courtesy and knowledge of your doctor. Excellent Fair Good Poor 8. Your doctor explained things in a way you could understand Excellent Fair Good Poor 9. Your doctor listened to and understood your needs as a patient Excellent Fair Good Poor 10. Your doctor's explanation of your condition Excellent Fair Good Poor 11. Overall satisfaction with your doctor and his staff Excellent Fair Good Poor 1. Are you a new patient? Yes No 2. Is your injury work related? Yes No 3. Were follow-up care instructions provided? Yes No 4. Would you recommend your doctor to your friends and family? Yes No 5. What suggestions do you have for how we can improve our services? By checking this box, I give my permission for testimonial to possibly be used on the Motion Orthopaedics website (No last names will be used Yes No Follow up information (optional) Name? Age? Email? Phone?