* 1. Were you satisfied with the helpfulness of the OIS chaperone?

* 2. Were you happy with the wait time to see the Doctor?

* 3. Did the Doctor do a good job with assessing your injury?

* 4. Was care and prevention of the injury discussed in a clear and understandable way?

* 5. Did the Doctor take time to answer any questions or concerns you may have had?

* 6. Was there a case conference done with your employer while you were in the room?

* 7. Did the OIS chaperone explain to you what the next step after your visit was?

* 8. Did the OIS chaperone schedule specialist's appointments or follow up appointments?

* 9. Would you recommend Eaglesmed OIS program to others?

* 10. Do you have any additional comments or concerns?

T