Patient Survey

Please fill-out the survey below and let us know how your experience was with us. We take input from our patients seriously and guarantee your confidentiality.

General Information

Patient Name: *

Type of Appointment: *

Physician Seen: *

Reception

Was the Administrative Assistance helpful and informative at check-in?:

Yes

How long was your wait in the wait room?:

Were you informed that the physician was delayed?:

Yes

Billing

Did you have any billing questions or concerns?:

Yes

If Yes, did the billing staff and your questions or concerns in a helpful manner?:

Yes

Other

How would you rate your overall experience at Mountain Orthopaedics?:

Excellent

Good

Fair

Poor

Would you like a response from our Office Manager?:

Yes

E-mail (optional):

Additional Information:

CAPTCHA

This question is for testing whether you are a human visitor and to prevent automated spam submissions.

Math question: * 2 + 9 =

Solve this simple math problem and enter the result. E.g. for 1+3, enter 4.

Patient Survey

Locations