Patient Satisfaction Survey 2021

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* 1. Have you had surgery within the last 6 weeks?

YES

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* 2. Please indicate the name of the doctor(s) you received treatment from at Newport Orthopedic Institute

Alan Beyer, MD

James Caillouette, MD

Balaji Charlu, MD

Brian Jin Choi, MD

Shaunak Desai, MD

Taylor Dunphy, MD

David Gazzaniga, MD

Andrew Gerken, MD

Michael Gordon, MD

Tze Ip, MD

Richard Lee, MD

Ram Mudiyam, MD

Nader Nassif, MD

Russell Petrie, MD

Emilia Ravski, DO

Kimberly Safman, MD

Christina Seifert, MD

Matthew Siljander, MD

James Ting, MD

William Wang, MD

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* 3. At which location(s) did you receive care?

Newport Beach Office

Huntington Beach Office

Irvine Office

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* 4. Which of the following best describes your health insurance status?

HMO

PPO

Medicare

Self Pay

Other

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* 5. On average, how long did you wait to see your provider?

Less than 15 minutes

15 - 30 minutes

31 - 45 minutes

46 - 60 minutes

More than 1 hour

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* 6. How satisfied were you with the following?

	Extremely Satisfied	Very Satisfied	Satisfied	Very Dissatisfied	Extremely Dissatisfied
A. Ease of making an appointment by phone	A. Ease of making an appointment by phone Extremely Satisfied	A. Ease of making an appointment by phone Very Satisfied	A. Ease of making an appointment by phone Satisfied	A. Ease of making an appointment by phone Very Dissatisfied	A. Ease of making an appointment by phone Extremely Dissatisfied
B. Getting an appointment in a reasonable amount of time	B. Getting an appointment in a reasonable amount of time Extremely Satisfied	B. Getting an appointment in a reasonable amount of time Very Satisfied	B. Getting an appointment in a reasonable amount of time Satisfied	B. Getting an appointment in a reasonable amount of time Very Dissatisfied	B. Getting an appointment in a reasonable amount of time Extremely Dissatisfied
C. Location of your appointment	C. Location of your appointment Extremely Satisfied	C. Location of your appointment Very Satisfied	C. Location of your appointment Satisfied	C. Location of your appointment Very Dissatisfied	C. Location of your appointment Extremely Dissatisfied
D. The efficiency of the check-in process	D. The efficiency of the check-in process Extremely Satisfied	D. The efficiency of the check-in process Very Satisfied	D. The efficiency of the check-in process Satisfied	D. The efficiency of the check-in process Very Dissatisfied	D. The efficiency of the check-in process Extremely Dissatisfied
E. The friendliness, courtesy and sensitivity to your needs by our staff	E. The friendliness, courtesy and sensitivity to your needs by our staff Extremely Satisfied	E. The friendliness, courtesy and sensitivity to your needs by our staff Very Satisfied	E. The friendliness, courtesy and sensitivity to your needs by our staff Satisfied	E. The friendliness, courtesy and sensitivity to your needs by our staff Very Dissatisfied	E. The friendliness, courtesy and sensitivity to your needs by our staff Extremely Dissatisfied
F. Waiting time in the reception area	F. Waiting time in the reception area Extremely Satisfied	F. Waiting time in the reception area Very Satisfied	F. Waiting time in the reception area Satisfied	F. Waiting time in the reception area Very Dissatisfied	F. Waiting time in the reception area Extremely Dissatisfied
G. Waiting time in the exam room	G. Waiting time in the exam room Extremely Satisfied	G. Waiting time in the exam room Very Satisfied	G. Waiting time in the exam room Satisfied	G. Waiting time in the exam room Very Dissatisfied	G. Waiting time in the exam room Extremely Dissatisfied

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* 7. How Satisfied are you with the following?

	Extremely Satisfied	Very Satisfied	Satisfied	Very Dissatisfied	Extremely Dissatisfied
A. Ease of navigating our phone system?	A. Ease of navigating our phone system? Extremely Satisfied	A. Ease of navigating our phone system? Very Satisfied	A. Ease of navigating our phone system? Satisfied	A. Ease of navigating our phone system? Very Dissatisfied	A. Ease of navigating our phone system? Extremely Dissatisfied
B. The ease of which it took to reach a live person on the phone?	B. The ease of which it took to reach a live person on the phone? Extremely Satisfied	B. The ease of which it took to reach a live person on the phone? Very Satisfied	B. The ease of which it took to reach a live person on the phone? Satisfied	B. The ease of which it took to reach a live person on the phone? Very Dissatisfied	B. The ease of which it took to reach a live person on the phone? Extremely Dissatisfied
C. When you reached a live person, were they pleasant and helpful?	C. When you reached a live person, were they pleasant and helpful? Extremely Satisfied	C. When you reached a live person, were they pleasant and helpful? Very Satisfied	C. When you reached a live person, were they pleasant and helpful? Satisfied	C. When you reached a live person, were they pleasant and helpful? Very Dissatisfied	C. When you reached a live person, were they pleasant and helpful? Extremely Dissatisfied
D. Ease to reach the correct person on the phone?	D. Ease to reach the correct person on the phone? Extremely Satisfied	D. Ease to reach the correct person on the phone? Very Satisfied	D. Ease to reach the correct person on the phone? Satisfied	D. Ease to reach the correct person on the phone? Very Dissatisfied	D. Ease to reach the correct person on the phone? Extremely Dissatisfied
E. If you left a message, was your message returned with in 24 hours?	E. If you left a message, was your message returned with in 24 hours? Extremely Satisfied	E. If you left a message, was your message returned with in 24 hours? Very Satisfied	E. If you left a message, was your message returned with in 24 hours? Satisfied	E. If you left a message, was your message returned with in 24 hours? Very Dissatisfied	E. If you left a message, was your message returned with in 24 hours? Extremely Dissatisfied

Comments:

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* 8. How satisfied were you with your visits to the provider (Doctor, Physician Assistant or Nurse Practitioner)?

	Extremely Satisfied	Very Satisfied	Satisfied	Very Dissatisfied	Extremely Dissatisfied
A. Their willingness to listen carefully to you	A. Their willingness to listen carefully to you Extremely Satisfied	A. Their willingness to listen carefully to you Very Satisfied	A. Their willingness to listen carefully to you Satisfied	A. Their willingness to listen carefully to you Very Dissatisfied	A. Their willingness to listen carefully to you Extremely Dissatisfied
B. Their explanation about your problem/condition	B. Their explanation about your problem/condition Extremely Satisfied	B. Their explanation about your problem/condition Very Satisfied	B. Their explanation about your problem/condition Satisfied	B. Their explanation about your problem/condition Very Dissatisfied	B. Their explanation about your problem/condition Extremely Dissatisfied
C. The amount of time your provider spent with you	C. The amount of time your provider spent with you Extremely Satisfied	C. The amount of time your provider spent with you Very Satisfied	C. The amount of time your provider spent with you Satisfied	C. The amount of time your provider spent with you Very Dissatisfied	C. The amount of time your provider spent with you Extremely Dissatisfied
D. Instructions you received about follow-up care	D. Instructions you received about follow-up care Extremely Satisfied	D. Instructions you received about follow-up care Very Satisfied	D. Instructions you received about follow-up care Satisfied	D. Instructions you received about follow-up care Very Dissatisfied	D. Instructions you received about follow-up care Extremely Dissatisfied
E. Empathized and understood what you are going through	E. Empathized and understood what you are going through Extremely Satisfied	E. Empathized and understood what you are going through Very Satisfied	E. Empathized and understood what you are going through Satisfied	E. Empathized and understood what you are going through Very Dissatisfied	E. Empathized and understood what you are going through Extremely Dissatisfied

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* 9. Did you receive a reminder Text or Email for your appointment and were you notified of the location?

Yes, and I was notified of the location

Yes, but wasn't told the location

N/A

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* 10. When leaving a message for your physician's surgery or procedure scheduler (i.e. injections), did you receive a response with 24-48 hours?

Yes

N/A

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* 11. How would you rate our staff's response time to your medical questions throughout your surgical or procedure experience (pre-surgery to post-surgery)?

Excellent

Very Good

Good

Fair

Poor

N/A

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* 12. Did you feel prepared for your surgery? Please tell us why or why not below.

Yes

N/A

Please tell us why:

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* 13. If any, please detail any issues with payments, bills or any frustrations regarding your financial experience during your treatment with your doctor.

Yes

N/A

If yes, please explain here:

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* 14. How would you rate the Following:

	Clean and Organized	Somewhat Clean	A Little Disorganized	Very Disorganized	Completely Disorganized
Cleanliness of the Waiting Room	Cleanliness of the Waiting Room Clean and Organized	Cleanliness of the Waiting Room Somewhat Clean	Cleanliness of the Waiting Room A Little Disorganized	Cleanliness of the Waiting Room Very Disorganized	Cleanliness of the Waiting Room Completely Disorganized
Appearance of the Reception Desk	Appearance of the Reception Desk Clean and Organized	Appearance of the Reception Desk Somewhat Clean	Appearance of the Reception Desk A Little Disorganized	Appearance of the Reception Desk Very Disorganized	Appearance of the Reception Desk Completely Disorganized
Cleanliness of the Exam Room	Cleanliness of the Exam Room Clean and Organized	Cleanliness of the Exam Room Somewhat Clean	Cleanliness of the Exam Room A Little Disorganized	Cleanliness of the Exam Room Very Disorganized	Cleanliness of the Exam Room Completely Disorganized
Cleanliness of the Bathroom	Cleanliness of the Bathroom Clean and Organized	Cleanliness of the Bathroom Somewhat Clean	Cleanliness of the Bathroom A Little Disorganized	Cleanliness of the Bathroom Very Disorganized	Cleanliness of the Bathroom Completely Disorganized
Appearance of the Staff	Appearance of the Staff Clean and Organized	Appearance of the Staff Somewhat Clean	Appearance of the Staff A Little Disorganized	Appearance of the Staff Very Disorganized	Appearance of the Staff Completely Disorganized
Overall Appearance of the Office	Overall Appearance of the Office Clean and Organized	Overall Appearance of the Office Somewhat Clean	Overall Appearance of the Office A Little Disorganized	Overall Appearance of the Office Very Disorganized	Overall Appearance of the Office Completely Disorganized

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* 15. Would you recommend Newport Orthopedic Institute to your family or friends?

Definitely Would

Probably Would

Not Sure

Probably Would Not

Definitely Would Not

Additional Comments:

Patient Satisfaction Survey 2021

Question Title

* 1. Have you had surgery within the last 6 weeks?

Question Title

* 2. Please indicate the name of the doctor(s) you received treatment from at Newport Orthopedic Institute

Question Title

* 3. At which location(s) did you receive care?

Question Title

* 4. Which of the following best describes your health insurance status?

Question Title

* 5. On average, how long did you wait to see your provider?

Question Title

* 6. How satisfied were you with the following?

Question Title

* 7. How Satisfied are you with the following?

Question Title

* 8. How satisfied were you with your visits to the provider (Doctor, Physician Assistant or Nurse Practitioner)?

Question Title

* 9. Did you receive a reminder Text or Email for your appointment and were you notified of the location?

Question Title

* 10. When leaving a message for your physician's surgery or procedure scheduler (i.e. injections), did you receive a response with 24-48 hours?

Question Title

* 11. How would you rate our staff's response time to your medical questions throughout your surgical or procedure experience (pre-surgery to post-surgery)?

Question Title

* 12. Did you feel prepared for your surgery? Please tell us why or why not below.

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* 13. If any, please detail any issues with payments, bills or any frustrations regarding your financial experience during your treatment with your doctor.

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* 14. How would you rate the Following:

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* 15. Would you recommend Newport Orthopedic Institute to your family or friends?

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* 16. What else can Newport Orthopedic Institute do to improve your overall patient experience?

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* 17. Name (optional) and contact information: