NOPCO Patient Satisfaction Survey 7/2012 Question Title * 1. Patient name (optional): Question Title * 2. Please select the clinic location where you were seen: Beth Israel Brookline Ave. Burlington Children's Hospital Boston CHOP East Brunswick Exeter Mountainside Neptune Lawrence Philly Somersworth Voorhees Waltham Weymouth Question Title * 3. Please enter the date of your service: Question Title * 4. Was your appointment scheduled in a reasonable amount of time? Yes No Question Title * 5. Were you seen within 15 minutes of your scheduled appointment? Yes No Question Title * 6. How satisfied are you with the friendliness/professionalism of our office staff? Very Somewhat Not at all Question Title * 7. Did your prescribed orthosis/prosthesis meet your expectations? Yes No Question Title * 8. Did your clinician introduce himself/herself? Yes No Question Title * 9. If yes, what was his/her name? Ryan Lauman Alyssa Perry Audrey Beatty Ben Goldstein Brad Varney Calli Clark Chelsey Anderson Chris Nelson Daryl Fornuff David Grazide Hector Paez Jamie Gandert Jesse Anderson Jim Wynne John Emery John Berteletti Katie Marshall Kelli Huber Kelly Bernard Kevin Holl Larry Miller Laura Norville Lisa Cherry Mike Azarian Mike Kitchen Nick Ricardi Radha Bakshi Rick Burnham Rusty Miller Scott Lafferty Steve Beaudoin Steve Carovillano Steve Slawinski Tom Harrigan Tom Grant Question Title * 10. In your opinion, did the practitioner answer the following questions to your satisfaction? Yes No Purpose and function of device? Purpose and function of device? Yes Purpose and function of device? No Instructions as how to wear your device? Instructions as how to wear your device? Yes Instructions as how to wear your device? No How to care for and maintain your device? How to care for and maintain your device? Yes How to care for and maintain your device? No Contact office if you have any problems? Contact office if you have any problems? Yes Contact office if you have any problems? No Question Title * 11. Did the office staff answer all your questions concerning billing and payment responsibilities? Yes No Question Title * 12. How satisfied are you with the friendliness/professionalism of our clinical staff? Very Somewhat Not at all Question Title * 13. Based on the products and services which you received, would you recommend this facility to friends and relatives? Yes No Question Title * 14. How would you rate your overall experience with NOPCO (5 being excellent, 1 being poor)? 1 2 3 4 5 Question Title * 15. Please provide any additional feedback you may have here: Done