At Appalachian Orthopedic Center, our goal is to provide the best care possible to our patients. In order to do so, we are asking that you complete the following questionnaire and provide us with valuable feedback that we will use to keep our patients satisfied with our physicians and staff. Your responses are strictly confidential and your name is not required, so you’re encouraged to use this opportunity to respond freely.

Thank you for taking the time to respond. We appreciate your time and effort!

Patient Satisfaction Survey

Physician's Name
Patient's Name (optional)
•How long have you been a patient of Appalachian Orthopedics?
•How did you hear about our practice?
•Please provide your referring physician's name.
•Approximately how many minutes did you wait after you arrived until you were called back to an exam room?
•Approximately how many minutes did you wait in an exam room before you were seen by a physician?

Please rate the services you received from Appalachian Orthopedic Center

Choose number that best describes your most recent experience:
1-Poor 2-Fair 3-Good 4-Excellent
•Ease of appointment scheduling:
•The helpfulness on the telephone of the front office staff:
•The helpfulness on the telephone of the clinical staff, if applicable:
•Front office staff promptness in returning your calls:
•Clinical staff promptness in returning your calls, if applicable:
•Your wait time before going to an exam room:
•Comfort of the exam room:
•The concern the clinical staff showed for your problem:
•The friendliness and courtesy shown by our staff:
•The explanations the doctor gave you about your problem or condition:
•The concern the clinical staff showed for your problem:
•The amount of time the doctor spent with you:
•Information you received about medications, if applicable:
•Instructions you received about follow up care, if applicable:
•Helpfulness in scheduling any special studies ordered by our doctors:
•Helpfulness of the billing staff, if applicable:
•Your confidence in the doctor:
•Our concern for your privacy:
•Your overall rating of the care you received during your most recent visit:
•Would you recommend our practice to friends and family members?
Why or why not?
•Would you like to mention any staff members that were especially helpful?
•What suggestions do you have for how we can improve our services?
Additional Comments: