Patient Survey

Name*
First Last
Email*
Enter Email Confirm Email
Gender
- Male
- Female
Age
Doctor Seen
Visit Date
MM slash DD slash YYYY
Communication with Seaview Orthopaedics
In general, there is good response time when communicating with the office.
- Strongly Agree
- Agree
- Uncertain
- Disagree
- Strongly Disagree
When I call the office for a prescription refill, I get a timely response.
- Strongly Agree
- Agree
- Uncertain
- Disagree
- Strongly Disagree
When I contact the office with a medical question or concern, it is addressed in a timely fashion.
- Strongly Agree
- Agree
- Uncertain
- Disagree
- Strongly Disagree
It is important for me to have an electronic method (Patient Portal) to communicate with the office.
- Strongly Agree
- Agree
- Uncertain
- Disagree
- Strongly Disagree
It is easy to use the Patient Portal.
- Strongly Agree
- Agree
- Uncertain
- Disagree
- Strongly Disagree
The Patient Portal meets my needs when trying to communicate with the office.
- Strongly Agree
- Agree
- Uncertain
- Disagree
- Strongly Disagree
Access
It is easy for me to schedule my appointment.
- Strongly Agree
- Agree
- Uncertain
- Disagree
- Strongly Disagree
The person who scheduled my appointment was courteous.
- Strongly Agree
- Agree
- Uncertain
- Disagree
- Strongly Disagree
The office hours are convenient for me.
- Strongly Agree
- Agree
- Uncertain
- Disagree
- Strongly Disagree
I was seen by the doctor within a reasonable amount of time of my scheduled appointment.
- Strongly Agree
- Agree
- Uncertain
- Disagree
- Strongly Disagree
The staff in the reception area was courteous.
- Strongly Agree
- Agree
- Uncertain
- Disagree
- Strongly Disagree
I was kept waiting in the patient room for a longer time than I expected.
- Strongly Agree
- Agree
- Uncertain
- Disagree
- Strongly Disagree
Doctor: Regarding the doctor I most recently saw
I thought the doctor spent enough time with me for my concerns.
- Strongly Agree
- Agree
- Uncertain
- Disagree
- Strongly Disagree
My doctor treated me in a very friendly and courteous manner.
- Strongly Agree
- Agree
- Uncertain
- Disagree
- Strongly Disagree
The instructions the doctor gave me about my condition/treatment plan were easily understood.
- Strongly Agree
- Agree
- Uncertain
- Disagree
- Strongly Disagree
I would say the doctor listened to me carefully.
- Strongly Agree
- Agree
- Uncertain
- Disagree
- Strongly Disagree
The doctor included me in decisions regarding my treatment plan.
- Strongly Agree
- Agree
- Uncertain
- Disagree
- Strongly Disagree
I have confidence in this doctor.
- Strongly Agree
- Agree
- Uncertain
- Disagree
- Strongly Disagree
I would recommend this doctor to my family/friends.
- Strongly Agree
- Agree
- Uncertain
- Disagree
- Strongly Disagree
Additional Comments
If you feel there is anything not addressed in this survey, or if you have personal comments you would like to share with us, please use the following space provided. Thank you for your time. Please know that your input will help our practice maintain our patient-centered goals. We look forward to providing you with continued orthopedic and pain management care in the future.
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