Skip to content
Patient Satisfaction Survey 2021
*
1.
Have you had surgery within the last 6 weeks?
(Required.)
YES
NO
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
3.
At which location(s) did you receive care?
Newport Beach Office
Huntington Beach Office
Irvine Office
4.
Which of the following best describes your health insurance status?
HMO
PPO
Medicare
Self Pay
Other
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
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
Extremely Satisfied
Very Satisfied
Satisfied
Very Dissatisfied
Extremely Dissatisfied
B. Getting an appointment in a reasonable amount of time
Extremely Satisfied
Very Satisfied
Satisfied
Very Dissatisfied
Extremely Dissatisfied
C. Location of your appointment
Extremely Satisfied
Very Satisfied
Satisfied
Very Dissatisfied
Extremely Dissatisfied
D. The efficiency of the check-in process
Extremely Satisfied
Very Satisfied
Satisfied
Very Dissatisfied
Extremely Dissatisfied
E. The friendliness, courtesy and sensitivity to your needs by our staff
Extremely Satisfied
Very Satisfied
Satisfied
Very Dissatisfied
Extremely Dissatisfied
F. Waiting time in the reception area
Extremely Satisfied
Very Satisfied
Satisfied
Very Dissatisfied
Extremely Dissatisfied
G. Waiting time in the exam room
Extremely Satisfied
Very Satisfied
Satisfied
Very Dissatisfied
Extremely Dissatisfied
7.
How Satisfied are you with the following?
Extremely Satisfied
Very Satisfied
Satisfied
Very Dissatisfied
Extremely Dissatisfied
A. Ease of navigating our phone system?
Extremely Satisfied
Very Satisfied
Satisfied
Very Dissatisfied
Extremely Dissatisfied
B. The ease of which it took to reach a live person on the phone?
Extremely Satisfied
Very Satisfied
Satisfied
Very Dissatisfied
Extremely Dissatisfied
C. When you reached a live person, were they pleasant and helpful?
Extremely Satisfied
Very Satisfied
Satisfied
Very Dissatisfied
Extremely Dissatisfied
D. Ease to reach the correct person on the phone?
Extremely Satisfied
Very Satisfied
Satisfied
Very Dissatisfied
Extremely Dissatisfied
E. If you left a message, was your message returned with in 24 hours?
Extremely Satisfied
Very Satisfied
Satisfied
Very Dissatisfied
Extremely Dissatisfied
Comments:
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
Extremely Satisfied
Very Satisfied
Satisfied
Very Dissatisfied
Extremely Dissatisfied
B. Their explanation about your problem/condition
Extremely Satisfied
Very Satisfied
Satisfied
Very Dissatisfied
Extremely Dissatisfied
C. The amount of time your provider spent with you
Extremely Satisfied
Very Satisfied
Satisfied
Very Dissatisfied
Extremely Dissatisfied
D. Instructions you received about follow-up care
Extremely Satisfied
Very Satisfied
Satisfied
Very Dissatisfied
Extremely Dissatisfied
E. Empathized and understood what you are going through
Extremely Satisfied
Very Satisfied
Satisfied
Very Dissatisfied
Extremely Dissatisfied
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
No
N/A
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
No
N/A
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
12.
Did you feel prepared for your surgery? Please tell us why or why not below.
Yes
No
N/A
Please tell us why:
13.
If any, please detail any issues with payments, bills or any frustrations regarding your financial experience during your treatment with your doctor.
Yes
No
N/A
If yes, please explain here:
14.
How would you rate the Following:
Clean and Organized
Somewhat Clean
A Little Disorganized
Very Disorganized
Completely Disorganized
Cleanliness of the Waiting Room
Clean and Organized
Somewhat Clean
A Little Disorganized
Very Disorganized
Completely Disorganized
Appearance of the Reception Desk
Clean and Organized
Somewhat Clean
A Little Disorganized
Very Disorganized
Completely Disorganized
Cleanliness of the Exam Room
Clean and Organized
Somewhat Clean
A Little Disorganized
Very Disorganized
Completely Disorganized
Cleanliness of the Bathroom
Clean and Organized
Somewhat Clean
A Little Disorganized
Very Disorganized
Completely Disorganized
Appearance of the Staff
Clean and Organized
Somewhat Clean
A Little Disorganized
Very Disorganized
Completely Disorganized
Overall Appearance of the Office
Clean and Organized
Somewhat Clean
A Little Disorganized
Very Disorganized
Completely Disorganized
*
15.
Would you recommend Newport Orthopedic Institute to your family or friends?
(Required.)
Definitely Would
Probably Would
Not Sure
Probably Would Not
Definitely Would Not
Additional Comments:
16.
What else can Newport Orthopedic Institute do to improve your overall patient experience?
17.
Name (optional) and contact information:
Current Progress,
0 of 17 answered