Satisfaction Survey

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:

SATISFACTION SURVEY

Were you and your child treated in a friendly and professional manner by the staff

Were you and your child treated in a friendly and professional manner by the orthotist

Were your questions or problems addresed to your satisfaction by the staff

Were your questions or problems addresed to your satisfaction by the orthotist

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

Please evaluate your childs orthosis design

Please evaluate your childs orthosis quality of workmanship

Please evaluate your childs orthosis quality of fit

Please evaluate your childs orthosis comfort

Please evaluate your childs orthosis improvement of function

Please evaluate your childs orthosis 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 *