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Satisfaction
Survey
Step 1 of 3
33%
First Impressions
Were you provided a convenient appointment time?
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Yes
No
How would you rate the promptness of attention at registration?
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Excellent
Very Good
Good
Fair
Poor
Clinical Care
Did you gain a clear and improved understanding of your shoulder diagnosis?
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Yes
No
How would you rate your explanation of your clinical ndings & treatment options
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Excellent
Very Good
Good
Fair
Poor
How would you rate the time and attention giving to you during your visit?
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Excellent
Very Good
Good
Fair
Poor
Were your questions answered to your satisfaction?
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Yes
No
N/A
Treatment
Did you gain an improved understanding of self-management techniques?
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Yes
No
N/A
Did you receive a prescription for:
Physiotherapy
*
Yes
No
Anti Inflammatory
*
Yes
No
Did you receive a cortisone injection?
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Yes
No
If cortisone injection was received, how would you rate the providers explanation of the treatment prior to injection?
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N/A
Excellent
Very Good
Good
Fair
Poor
Overall
How would you rate the care & services you received?
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Excellent
Very Good
Good
Fair
Poor
Did the clinic visit meet your expectations?
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Yes
No
How would you rate the professionalism of our staff?
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Excellent
Very Good
Good
Fair
Poor
Please Share Any Additional Comments
Would you like the clinic management to contact you to further discuss any concerns/feedback?
*
Yes
No
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