Patient Satisfaction Survey

Patient Satisfaction Survey

Your Opinion counts!

Patient Name (required)

Patient Email (required)

Patient Age (required)

Type of device worn (required)

PLEASE RATE US ON A SCALE OF 1-5 WITH 5 INDICATING EXCELLENT AND 1 POOR

SELECT THE NUMBER YOU FEEL MOST APPROPRIATE

1. My appointment was scheduled in a reasonable amount of time and the person whom I spoke with was courteous and helpful.

2. I was seen within 15 minutes of my appointment and if not, the reason for the delay was explained to me.

3. I found the waiting and treatment areas clean and well maintained.

4. The services provided to me were delivered in a reasonable amount of time.

5. Considering its limitations. I found the fit and function of my orthotics / prosthesis satisfactory.

6. I have found that my orthosis / prothesis is adequate for my needs.

7. The appearance and workmanship of my orthosis / prothesis is to my satisfaction.

8. the Orthotist / Prosthetist who provided my service, was knowledgable and skillful.

9. Overall, I was satisfied with the quality of treatment I received.

10. I received specific recommendations and/or instructions on proper care and use of my orthosis / prothesis.

11. I would recommend Pro-Fit to others requiring such services.

12. Would you like to speak to someone about the services provided?

What do you feel needs to be improved?

Would you like to provide a Testimonial?