Nirschl Orthopaedic Clinic Survey
1.
How long have you been a patient at Nirschl Orthopaedic Clinic?
Less than 6 months
6 months to less than 1 year
1 year to less than 3 years
3 years to less than 5 years
5 years or more
2.
How would you rate your level of satisfaction with us?
Highly satisfied
Somewhat satisfied
Neutral
Somewhat dissatisfied
Highly dissatisfied
3.
How satisfied were you with:
 Highly Dissatisfied Dissatisfied Somewhat Dissatisfied Somewhat Satisfied Satisfied Highly Satisfied 
The registration process
The timeliness of your appointment
The way information was shared with you
The overall care given by the staff
The overall care given by the doctor
  • Comment:

  • 500 character(s) left.
4.
How much do you agree with the following?
 Strongly Disagree Disagree Somewhat Disagree Somewhat Agree Agree Strongly Agree 
The doctor treated me with respect
The doctor listened to me
The doctor seemed to care about my feelings
The doctor and staff worked well as a team
The doctor told me all I needed to know
The staff helped me when I needed help
I felt comfortable asking questions
I was comfortable during the exam
I understand the proposed treatment plan
I know who to call if I have questions
  • Comment:

  • 500 character(s) left.
5.
How likely are you to continue doing business with us?
Very likely
Somewhat likely
Neutral
Somewhat unlikely
Very unlikely
6.
How likely is it that you would recommend our physicians to a friend or colleague?
Very likely
Somewhat likely
Neutral
Somewhat unlikely
Very unlikely
7.
I would returrn to Nirschl Orthopaedic for other treatments.
Yes
No
  • Comment:

  • 500 character(s) left.
8.
Do you have any suggestions for improving your patient experience?
 

  • 350 character(s) left.
9.
What is your gender?
Male
Female
Prefer not to answer
10.
Which category describes your age?
Younger than 18
18 - 24
25 - 34
35 - 44
45 - 54
55 - 64
65 or older
Prefer not to answer