Patient Survey Question Title * 1. Name of doctor: Dr Philip Brook Dr Jonathan Cabot A/Prof Peter Cundy Dr George Dracopoulos Dr David Hermann Dr M. Saleem Hussenbocus Dr Mark Inglis Dr Meng Ling Dr Matthew Liptak Dr Yu Chao Lee Dr Daniel Mandziak Dr James McLean Dr Andrew Mintz Dr Mario Penta Dr Andrew Potter Dr Anthony Samson Dr Aman Sood Dr Aaron Stevenson Dr Peter Viiret Dr Brian Wallace Dr Jason Ward Dr Darren Waters Dr Justin Webb Dr Nicole Williams Prof Brian Freeman Question Title * 2. Location of appointment: Memorial Medical Centre Ashford Specialist Centre Flinders Private Parkside Central Districts Other (please specify) Question Title * 3. How likely is it that you would recommend Doctor to a friend or colleague? Not at all likely Extremely likely 0 1 2 3 4 5 6 7 8 9 10 0 1 2 3 4 5 6 7 8 9 10 Question Title * 4. On a scale of 1-10 (1 being poor and 10 being exceptional) how friendly were the Orthopaedics SA office staff? 1 2 3 4 5 6 7 8 9 10 Question Title * 5. On a scale of 1-10 (1 being poor and 10 being exceptional) how easy was it to schedule your appointment at a time that was convenient for you? 1 2 3 4 5 6 7 8 9 10 Question Title * 6. On a scale of 1-10 (1 being poor and 10 being exceptional) how satisfied were you with the amount of time the specialist spent with you to address your needs? 1 2 3 4 5 6 7 8 9 10 Question Title * 7. On a scale of 1-10 (1 being poor and 10 being exceptional) how convenient is the location of our rooms for your specialist appointment? 1 2 3 4 5 6 7 8 9 10 Question Title * 8. How likely is it that you would recommend Orthopaedics SA to a friend or colleague? Not at all likely Extremely likely 0 1 2 3 4 5 6 7 8 9 10 0 1 2 3 4 5 6 7 8 9 10 Question Title * 9. Please make any further comments about your experiences with Orthopaedics SA: Question Title * 10. Please indicate who the survey was completed by: Patient Parent or guardian Other person Question Title * 11. Please tell us your postcode: Question Title * 12. Would you like our management team to contact you to discuss your patient survey response with you? (If yes, please leave your contact details below) Yes No Question Title * 13. Contact Information Name Phone Number Email On behalf of Orthopaedics SA thank you for completing this survey. Once submitted you will be automatically re-directed to the Orthopaedics SA website. Done
