painmanagement

PAIN MANAGEMENT

sports meds

SPORTS MEDICINE

elbow

ELBOW

hip

HIP

shoulder

SHOULDER

knee

KNEE

PATIENT SATISFACTION SURVEY

1. Which doctor are you seeing?
 Dr. Milne Dr. King Dr. Doll Dr. Farley

2. What was the purpose of your call or visit to the office?

3.How did you select us for your care today?

Please rate the following Excellent, Good, Fair, or Poor

1. Ease of scheduling appointment with your doctor.

2. Helpfulness and courtesy of staff.

3. Your information was collected in a confidential manner that maintained your privacy

4. Timeliness of being seen at your appointment time.

5. Time spent with your doctor.

6. Comfort of exam room.

7. Courtesy and knowledge of your doctor.

8. Your doctor explained things in a way you could understand

9. Your doctor listened to and understood your needs as a patient

10. Your doctor's explanation of your condition

11. Overall satisfaction with your doctor and his staff

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?

X

Tell a Friend

captcha