1. Was this your first visit?

2. Which Doctor did you visit?

3. Why did you decide to seek medical treatment at our office? Check all that apply.

4. If you are a member of an HMO, what is the name of your plan?

Please give us a grade in each of the following areas, use the following grading scale:
A=Excellent, B=Above Average, C=Average, D=Needs Improvement, F=Poor, NA=Not Applicable to My Visit

5. When I made my appointment, the telephone was answered promptly.

6. I was able to make an appointment promptly at a convenient time.

7. The staff that helped me make an appointment was courteous.

8. When I arrived, the reception desk staff was helpful and courteous.

9. The waiting room was comfortable and clean.

10. The wait time to see my physician was reasonable.

11. The nurse was helpful and courteous.

12. The X-Ray Department was helpful and courteous.

13. The Cast Technician was helpful and courteous.

14. The exam room was clean and comfortable.

15. My Doctor was interested in my problem.

16. My Doctor explained my illness and treatment.

17. I was satisfied with the medical treatment I received.

18. The staff that checked me out was helpful and courteous.

19. My overall visit to my Doctor at the Bone and Joint Clinic of Baton Rouge.

20. Comments:

21.What is your email address:

22. Would you like to receive email updates from The Bone and Joint Clinic?

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