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Satisfaction Survey

Orthocare Solutions was founded to provide the best customer service to our family of patients. Please let us know how we’re doing so we can continue to meet your needs, innovate, and uphold our service commitment.

Visit Information

Practitioner's Name

Date of Service Received

How satisfied were you in the following areas?

The Practitioner

1. The amount of time you waited to see your practitioner:

Very satisfied Satisfied Dissatisfied Very dissatisfied

2. The friendliness and professionalism of your practitioner:

Very satisfied Satisfied Dissatisfied Very dissatisfied

3. The amount of time your practitioner spent with you:

Very satisfied Satisfied Dissatisfied Very dissatisfied

The Orthosis/Prosthesis

1. Satisfaction with the overall quality, fit and comfort of your device:

Very satisfied Satisfied Dissatisfied Very dissatisfied

2. The completion of your device in a timely manner:

Very satisfied Satisfied Dissatisfied Very dissatisfied

3. The quality of information given on how to use, clean and care for your device:

Very satisfied Satisfied Dissatisfied Very dissatisfied

Our Staff

1. Were you able to schedule a convenient appointment?

Very satisfied Satisfied Dissatisfied Very dissatisfied

2. The friendliness and professionalism of our office staff:

Very satisfied Satisfied Dissatisfied Very dissatisfied

3. The explanation of our billing and payment policies:

Very satisfied Satisfied Dissatisfied Very dissatisfied

General

1. The appearance and cleanliness of our waiting area and patient/fitting room:

Very satisfied Satisfied Dissatisfied Very dissatisfied

2. Your overall satisfaction with Orthocare Solutions:

Very satisfied Satisfied Dissatisfied Very dissatisfied

Comments

Would you like our staff to contact you to set another appointment? *

Yes No

If Yes, please enter your name and phone number.

Name

Phone

How did you find us?

Doctor referral Phonebook Web page Other

Our Service Locations

Greenbelt | Columbia | Alexandria | Woodbridge

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5850 Waterloo Road, Suite 140
Columbia, MD 21045

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