Premier Orthopaedic Patient Satisfaction Survey
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Satisfaction Survey

We want to ensure our patients have the best possible experience at our Premier facilities. Taking the time to fill out this survey ensures Premier's ability to provide patients with the best care and customer service we typically pride ourselves on. We value your feedback.

1. Full Name:

Full Name:

2. What service(s) did you receive from Premier?

What service(s) did you receive from Premier? Physicians Visit

Physical Therapy

Imaging

EMG

Urgent Care

3. Which Site/Physician?

Which Site/Physician?

4. How would you describe your experience?

	Physicians	Physical Therapy	Imaging	EMG	Urgent Care
Excellent	*How would you describe your experience? Excellent Physicians	Excellent Physical Therapy	Excellent Imaging	Excellent EMG	Excellent Urgent Care
Good	Good Physicians	Good Physical Therapy	Good Imaging	Good EMG	Good Urgent Care
Fair	Fair Physicians	Fair Physical Therapy	Fair Imaging	Fair EMG	Fair Urgent Care
Poor	Poor Physicians	Poor Physical Therapy	Poor Imaging	Poor EMG	Poor Urgent Care

5. How did you hear about Premier?

How did you hear about Premier? Primary Doctor

Friend/Family

Newspaper

Website

I am a returning patient

Other (please specify)

6. Please rate how likely you are to refer a friend/family member to a Premier facility?

	Physicians	Physical Therapy	Imaging	EMG	Urgent Care
Very Likely	*Please rate how likely you are to refer a friend/family member to a Premier facility? Very Likely Physicians	Very Likely Physical Therapy	Very Likely Imaging	Very Likely EMG	Very Likely Urgent Care
Likely	Likely Physicians	Likely Physical Therapy	Likely Imaging	Likely EMG	Likely Urgent Care
Maybe	Maybe Physicians	Maybe Physical Therapy	Maybe Imaging	Maybe EMG	Maybe Urgent Care
Not Likely	Not Likely Physicians	Not Likely Physical Therapy	Not Likely Imaging	Not Likely EMG	Not Likely Urgent Care

7. Can you give any suggestions as to how Premier can improve in serving you?

Can you give any suggestions as to how Premier can improve in serving you?

8. Please enter your email address below if you would like to receive the latest news on advances in orthopaedics and healthcare from Premier.

Please enter your email address below if you would like to receive the latest news on advances in orthopaedics and healthcare from Premier.

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Premier Orthopaedic Patient Satisfaction SurveyExit this survey

Satisfaction Survey

Premier Orthopaedic Patient Satisfaction Survey
Exit this survey