OrthoNeuro: Patient Satisfaction Survey

OrthoNeuro
(614) 890-6555
info@orthoneuro1.com

1313 Olentangy River Rd.
Columbus, Ohio 43212

70 S. Cleveland Ave.
Westerville, Ohio 43081

4420 Refugee Rd.
Columbus, Ohio 43232

7277 Smith’s Mill Road
New Albany OH 43054

To better serve you, OrthoNeuro would like your feedback on the healthcare services you have received from us. We appreciate all your comments or suggestions. Please take a few minutes to fill out this confidential questionnaire and submit it to OrthoNeuro. If you choose to send us your name and phone number, you can fill that information in at the bottom of this form.

Thank you for your input.

1. How often have you been to OrthoNeuro?
First visit
2-5 visits
6 or more visits

Below are questions rating OrthoNeuro Services. PLEASE DO NOT MARK AN ANSWER IF YOU HAVE NOT HAD INTERACTION IN THIS AREA. Thank you.

2. Courtesy of the person who scheduled your appointment.
Excellent
Good
Satisfactory
Poor

3. Helpfulness on the telephone.
Excellent
Good
Satisfactory
Poor

4. General knowledge and competence of the Reception Area staff.
Excellent
Good
Satisfactory
Poor

5. Friendliness and competence of the nurse/assistant.
Excellent
Good
Satisfactory
Poor

6. Concern the nurse/assistant showed for your problem.
Excellent
Good
Satisfactory
Poor

7. Friendliness/courtesy of the provider.
Excellent
Good
Satisfactory
Poor

8. Explanations the provider gave you about your problem or condition.
Excellent
Good
Satisfactory
Poor

9. Provider's efforts to include you in decisions about your treatment.
Excellent
Good
Satisfactory
Poor

10. Instructions the provider gave you about follow-up care (if any).
Excellent
Good
Satisfactory
Poor

11. Your confidence in this provider.
Excellent
Good
Satisfactory
Poor

12. Our concern for your privacy.
Excellent
Good
Satisfactory
Poor

13. Overall rating of care received during your visit.
Excellent
Good
Satisfactory
Poor

14. Likelihood of your recommending OrthoNeuro to others.
Excellent
Good
Satisfactory
Poor

Your opinions and comments are important to us.

On behalf of our entire staff, thank you for choosing us. We have tried to live up to your expectations and provide you with a high level of service. Now we would like to know if we did indeed meet that goal.

So, thank you for taking a few minutes to complete this survey. Your responses, suggestions and recommendations will help us make improvements. Below you may provide additional feedback. Your honest evaluation is most important.

Thank you for taking the time to share your thoughts with us, and for letting us serve you.

Please comment:

If you would like us to contact you concerning your opinions or suggestions, please fill out the following:

Name:

Day Phone Number:

Date:

If you would like to provide additional comments please email us.