The Brace Center - Orthopedic & Sports Bracing
Patient Survey                                                            We appreciate your allowing us to provide services to you.  We are interested in your feedback to evaluate our effectiveness and improve our services to our patients. Please rate the following services:                                                                                          h
Courtesy of office staff on the phone:
Excellent
Good
Average
Fair
Unsatisfactory
Not Applicable
Courtesy of office staff during visit:
Excellent
Good
Average
Fair
Unsatisfactory
Not Applicable
Clear understanding of fees prior to treatment:
Excellent
Good
Average
Fair
Unsatisfactory
Not Applicable
Promptness of Practitioner Services:
Excellent
Good
Average
Fair
Unsatisfactory
Not Applicable
Cleanliness of patient rooms:
Excellent
Good
Average
Fair
Unsatisfactory
Not Applicable
Your Practitioner's listening skills:
Excellent
Good
Average
Fair
Unsatisfactory
Not Applicable
Clear understanding of proper wear and care of orthosis:
Excellent
Good
Average
Fair
Unsatisfactory
Not Applicable
Helpfulness of staff with billing questions:
Excellent
Good
Average
Fair
Unsatisfactory
Not Applicable
Rate your general state of health and functioning prior to treatment:
Excellent
Good
Average
Fair
Unsatisfactory
Not Applicable
Rate your general state of health and functioning after treatment:
Excellent
Good
Average
Fair
Unsatisfactory
Not Applicable
Comments and suggestions:
Date of Visit:




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