Patient Survey

Thank you for agreeing to take this brief survey. 

We place great value on providing quality care. Receiving your feedback is an essential step toward improving that quality. Your feedback, provided through this survey, will be used for this purpose as well as providing valuable testimonials for our practice. All personal information you provide will be kept confidential according to the standards of HIPAA.

 
1.
How did you hear about Dr. Gilmore and Panhandle Orthopaedics? (Please check all that apply.)
Another Doctor
Workers' Compensation
Family/Friend
Attorney
Our Website
Insurance Website
Phone-Book
Billboard
Other  
2.
Please select which medical provider(s) you saw at your appointment.
Dr. Michael Gilmore
Tony Zembrzuski, Physician Assistant
Melanie Broome, Physical Therapist
Bren Mejia, Physical Therapist Assistant
Delan Gilliam, Physical Therapist
Mike Zarger, Athletic Trainer
3.
Please select which Panhandle Orthopaedics location you attend(ed).
Crestview
Panama City
Pensacola
4.
About how many times have you visited Panhandle Orthopaedics?
1-5
6-15
16-25
25+
5.
How does our office staff, facility, and services rate on the following attributes?
If you were dissatisfied with any of these attributes; please tell us why in the comment box.  If a number doesn't apply to your visit, PLEASE leave it blank.
 Highly Dissatisfied Somewhat Dissatisfied Neutral Somewhat Satisfied Highly Satisfied 
Promptness of scheduling your appointment
Check-in experience
Satisfactory answers to financial and insurance questions
Professional and courteous service of office staff
Facility cleanliness and comfort
Check-out experience
Getting in-house medication experience
Calling in medication experience
Having in-house x-rays completed
Having in-house physical therapy experience
  • Comment:

  • 500 characters left.
6.
How does our care rate on the following attributes?
If you were dissatisfied with any of these attributes; please tell us why in the comment box.
 
 Not Applicable Highly Dissatisfied Somewhat Dissatisfied Neutral Somewhat Satisfied Highly Satisfied 
Explaining the next steps of your care
A clearly communicated explanation of your diagnosis
The answering of all your questions
Listening to you
The amount of time we spent with you during your visit
Our responsiveness to your needs
  • Comment:

  • 500 characters left.
7.
At this time, how would you rate your overall experience at Panhandle Orthopaedics?
If you were dissatisfied with your experience, please tell us why in the comment box below.
Not Applicable Highly Dissatisfied Somewhat Dissatisfied Neutral Somewhat Satisfied Highly Satisfied      
     
  • Comment:

  • 500 characters left.
8.
How close to your scheduled time did your appointment begin?
5 minutes
15 minutes
30 minutes
Other  
9.
If applicable to your situation, do you feel we were accurate in your diagnosis?
Yes
No
Not Applicable
10.
How would you rate the level of trust you have with our health care providers and their decisions for you?

If your level of trust for us was low, would you please share with us the reason why?

Very Low Low Not Applicable High Very High       
      
  • Comment:

  • 500 characters left.
11.
Are you likely to return to us if additional care is ever required? If you would not, would you please explain?
Yes
No
  • Comment:

  • 500 characters left.
12.
Would you recommend our services to others?
If you would not recommend our services, would you please share with us why?
Never Unlikely Not Applicable Somewhat Likely Likely       
      
  • Comment:

  • 500 characters left.
13.
How may we improve the way in which we provide care? (If you would like to be contacted directly by our Office Manager, please let us know in your comments below.)
 

1000 characters left.

Thank you.
We sincerely appreciate your valued participation. Feel free to contact us at (850)398-8480 if you have any questions or concerns.