1. Patient Satisfaction

Patients Name.

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* 1. Patients Name.

Please rate the professional manner in which our Practicioner presented himself.

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* 2. Please rate the professional manner in which our Practicioner presented himself.

How clear were the instructions on the care and use of your device?

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* 3. How clear were the instructions on the care and use of your device?

Please rate overall fit, comfort, and quality of your device.

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* 4. Please rate overall fit, comfort, and quality of your device.

The amount of time our practicioner spent with you was sufficent to answer all of your questions and concerns.

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* 5. The amount of time our practicioner spent with you was sufficent to answer all of your questions and concerns.

Were you able to get a convenient appointment time and date?

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* 6. Were you able to get a convenient appointment time and date?

How helpful was office personel in providing information?

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* 7. How helpful was office personel in providing information?

Please rate your overall experience with ORTHOLOGIX.

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* 8. Please rate your overall experience with ORTHOLOGIX.

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