Were you treated in a friendly and courteous manner by our staff?
*
Yes
No
Were you able to schedule a convenient appointment?
*
Yes
No
How long after your scheduled appointment time did you wait to see your practitioner?
*
Less than 5 minutes
5 to 15 minutes
More than 15 minutes
How comfortable was the waiting area?
*
Very good
Needs improvement
Did the staff inform you of your financial liability for denial of claim?
*
Yes
No
Did the staff inform you of your co-pay obligations?
*
Yes
No
How would you rate the knowledge, care and attention that the practitioner provided to you during your visit?
*
Well done!
Pretty good
Okay
Needs some help!
After your first appointment, how long before you received your device?
*
Less than a week
1-2 weeks
3-5 weeks
More than 1 month
Do you use your device on a daily basis or some other frequency?
*
Daily
3-5 times per week
Less than 3 days a week
Not at all
What is your opinion of the overall services provided by your practitioner?
*
Excellent
Ok
Could stand improvement
How useful were the instructions regarding the use & care of your device?
*
Very useful
Somewhat useful
Somewhat confusing
I didn't get instructions
Were your questions or concerns about your device answered to your satisfaction?
*
Yes
No
Were your questions or concerns about your care answered to your satisfaction?
*
Yes
No
How comfortable is your device?
*
I forgot I was wearing it
It feels fine
It's uncomfortable
It hurts sometimes
It hurts a lot
Are you satisfied with your device?
*
Yes
No
Were you instructed about whom to contact if a problem develops?
*
Yes
No
Would you recommend us to others if they were in need of similar services?
*
Yes
No
Why not?
*
Do you have any comments or suggestions you would like to offer in reference to any of the questions above or otherwise?
*
Your name
Email address
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