Rebound Orthopedics and Neurosurgery

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Patient Satisfaction Survey

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To assist in our effort to provide you with the very best care, please take a few minutes to complete this survey. When you have completed your survey, please press the submit button at the bottom of this page. All of your answers and comments will be kept confidential.

Date:
/ /

Your Physician or Physician Assistant:

Scheduling an Appointment
1.	Ease of contacting the doctor's office by phone
2.	Courtesy of the staff taking your call
3.	Time it took to get an appointment that was convenient for you
Registration Process
4.	Friendliness of the registration staff
5.	Registration staff's ability to answer your questions in a way you could understand
Waiting Time
6.	When you arrived in the reception area, how long did you wait before you saw the doctor?
Care you received from the nurses, technicians and medical assistants
7.	Courtesy of the nurses/techs/medical assistants who treated you
Care you received from the physician or physician assistant
8.	Courtesy of the health care provider who treated you
9.	The health care provider's explanation of what was done for you (test, diagnosis, treatment)
10.	Confidence you felt in the health care provider's medical skills

11.	I would recommend the Rebound Center to my family and friends
		Strongly Disagree
		Somewhat Disagree
		Neither Agree nor Disagree
		Somewhat Agree
		Strongly Agree

How can we improve our services to better meet your needs?

Would you like to be contacted by a Rebound representative?
Yes No

If yes, please include your name and daytime phone number

Name

Daytime Phone Number


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