Appointment Information
Date: *
Location *
Physician:
(select your physician)
Mark S. Fitzgerald, MD
Robert J. Greenhow, MD
Craig Loucks, MD
Hugh McPherson, MD
Lloyd W. Mobley III, MD
Please choose a reason for your visit(s) *
Please rate the following according to this scale
The length of time it took to get an appointment:
The amount of wait time in the reception area:
The amount of wait time to see your physician:
The manner in which you were treated by the front desk:
The manner in which you were treated by the clinic staff:
The manner in which you were treated by your physician:
The thoroughness of your medical evaluation:
The amount of time spent with your physician:
How well your medical concerns were addressed by physician:
Timeliness of returned phone calls by office staff:
Ease of surgery scheduling (if applicable):
Ease of getting a hold of office staff by phone:
Improvements
If there were one or two things about your office visit(s), which could be improved, what would it/they be?:
Other:
General Feedback
Please list any individuals who have given you less than desired care:
Please list any individuals who went/go above and beyond:
Would you refer your friends and family to our clinic?:
Additional Comments:
Thank you for your time!
If you would like to be contacted by our Practice Manager, leave your information here.
Usage Agreement
We are looking for patient testimonials to further enhance our patient experience:
Please feel free to contact us for clarification on how your information will be used. Peak Orthopedics and Spine may alter your survey information to maintain patient anonymity.
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