At Excelsior Orthopaedics, it is our goal to provide the best possible medical care. To do that, it is important that we know your thoughts about the care you are receiving. Your comments are strictly confidential and results will be used to improve service to our patients. By completing this survey, you will automatically be entered into a monthly drawing for a FREE $100 VISA gift card. Thank you very much for your time.

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* 1. What ID number appears on your "How did we do" card? (if any)

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* 2. Is this your first visit to our practice?

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* 3. How did you hear about Excelsior Orthopaedics?

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* 4. What location was your appointment at?

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* 5. Which provider (Doctor or Physician Assistant) did you see?

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* 6. When calling our office, were you satisfied with how promptly the phone was answered?

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* 7. Were you able to obtain an appointment in a timely fashion?

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* 8. Were you satisfied with the courtesy and professionalism of the person who answered your call?

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* 9. Were you satisfied with our staff that greeted you and collected your payment and insurance information?

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* 10. Did you find the reception area and waiting room to be comfortable and clean?

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* 11. Were you satisfied with the staff that placed you in the exam room and reviewed your medications and allergies?

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* 12. Were you satisfied with the time the provider (Doctor or Physician Assistant) spent with you?

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* 13. Were you satisfied with the provider’s explanation of your condition and treatment?

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* 14. Were you satisfied with the staff that helped you following your visit…to schedule your next appointment, or scheduled other testing (MRI, CT, EMG, etc.)

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* 15. Overall, how satisfied were you with your experience at Excelsior Orthopaedics?

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* 16. If you were dissatisfied with your experience at Excelsior, would you like a member of our team to contact you about your concerns or questions? If Yes, please be sure to complete the contact information on question 21.

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* 17. Would you return to the practice if you have another injury or problem?

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* 18. Would you recommend friends and family to our practice?

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* 19. Is there anyone specific (a favorite staff member) that you would like recognized and why?

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* 20. Are you aware that we have an urgent care service called “Excelsior Express” for urgent treatment of orthopaedic injuries open: (Monday - Friday 8:00 a.m. – 9:00 p.m.) and Saturdays (2:00 p.m. – 7:00 p.m.)?

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* 21. Would you like to share any other thoughts about your experience at Excelsior?

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* 22. To be eligible to win a FREE $100 VISA gift card, and/or if you would like someone from Excelsior to contact you about any concerns or questions you may have, please complete the following:

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