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* 1. Please select the option that best describes your most recent appointment with us?

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* 2. Which of our locations did you visit?

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* 3. Which provider(s) did you see? (check all that apply)

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* 4. Upon arrival, how would rate your experience with our administrative staff?

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* 5. How comfortable was our waiting area?

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* 6. For your scheduled appointment, were you seen

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* 7. Were your financial obligations explained to you?

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* 8. Please rate the level of knowledge, care and attention you received from your provider.

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* 9. Did you discuss your goals and objectives related to your care with your provider?

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* 10. Did you receive your device(s) when your provider indicated you would?

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* 11. How satisfied are you with your device(s)?

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* 12. Were you given complete instructions on your equipment/care?

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* 13. Would you recommend our practice to your friends or family if they had a need for our services?

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* 14. Please rate your overall satisfaction with the care you received at our practice.

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* 15. For Amputees Only: How comfortable is your socket if it was fabricated by P&O Solutions? (If you are currently wearing a socket made by another company, please skip this question.)

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* 16. Additional Comments or Feedback:

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* 17. Please provide your contact information (if you wish to remain anonymous you may skip this):

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