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Pediatric Orthotic Specialists conducts patient satisfaction surveys as a part of our 'Quality Assessment and Improvement' program.

Your input is very important to us. Please take a few moments and let us know how we are doing. Our goals are to provide superior orthotic treatment for you and your child. It is very helpful to us to hear how we can improve our service and to hear what we have done well.

Thank you for taking the time to help us help you better.

5=Excellent     4=Good       3=Average      2=Below Average       1=Poor
Were you and your child treated in a friendly and professional manner by:

The office Staff?

The orthotist?


Were your questions or problems addresed to your satisfaction by:

The office Staff?

The orthotist?


Were you informed of your co-pay and payment options by the office staff? (if applicable)

The office Staff?


Please evaluate your childs orthosis:


Quality of workmanship

Quality of fit

Your child's comfort

Improvement of function

Ease of use and care


Did you receive timely, appropriate follow up care?


Would you refer Pediatric Orthotic Specialists to a friend?


Why or why not?


Additional comments or suggestions-


Patient name*


Date of Birth*