* 1. Contact information. Optional.

* 2. Would you like someone from our office to contact you?

* 3. Please rate us on a scale of 1 to 5, with 1 indicating Poor and 5 indicating Excellent.

  1 2 3 4 5 N/A
My appointment was scheduled in a reasonable amount of time.
The person that scheduled my appointment with, was courteous and helpful.
I was seen within 15 minutes of my scheduled appointment.
I found the waiting and treatment areas clean and well maintained.
The services provided to me were delivered in a reasonable amount of time.
Considering it's limitations, I found the fit and function of the device satisfactory.
I have found my device appropriate for my needs.
The appearance and workmanship of my device is satisfactory.
The Practitioner who provided my service was knowledgeable and skillful.
Overall, I was satisfied with the quality treatment I received from Orthopro of Carson City.

* 4. Please answer the following questions.

  Yes NO
I received specific recommendations and/or instructions on proper care and use of my device.
I would recommend Orthopro of Carson City, Inc. to others requiring such service?
Were your questions or concerns about your care answered?
Were you educated on the function and precautions of the device?
Did you receive instructions on who to contact in case of emergency?
Were you informed or your financial responsibilities prior to receipt of your device?

* 5. Comments or suggestions for our improvement.