Peak Orthopedics & Spine
Better Techniques Mean Better Results   Peak Orthopedics & Spine: 303.699.Peak (7325)
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Patient Satisfaction Survey

In our ongoing attempt to provide the highest quality care and the best possible personal practice experience, we are asking select people and patients to participate in an important survey.

You have been selected to take part in this survey because we value your thoughts and impressions. We are extremely grateful for your time and consideration.

Fields marked (*) are compulsory

Appointment Information
Date: *
Location *
9777 S. Yosemite St #220, Lone Tree, CO 80124
14100 E. Arapahoe Rd. #370, Centennial, CO 80112
Physician:
Please choose a reason for your visit(s) *
Orthopedic injury/pain
Total joint replacement consultation
Referral from Emergency Room
Spine injury/pain
Brain/Neurological symptoms
Referral from primary care physician
Please rate the following according to this scale
The length of time it took to get an appointment:
1=Poor
2=Fair
3=Good
4=Very Good
5=Excellent
The amount of wait time in the reception area:
1=Poor
2=Fair
3=Good
4=Very Good
5=Excellent
The amount of wait time to see your physician:
1=Poor
2=Fair
3=Good
4=Very Good
5=Excellent
The manner in which you were treated by the front desk:
1=Poor
2=Fair
3=Good
4=Very Good
5=Excellent
The manner in which you were treated by the clinic staff:
1=Poor
2=Fair
3=Good
4=Very Good
5=Excellent
The manner in which you were treated by your physician:
1=Poor
2=Fair
3=Good
4=Very Good
5=Excellent
The thoroughness of your medical evaluation:
1=Poor
2=Fair
3=Good
4=Very Good
5=Excellent
The amount of time spent with your physician:
1=Poor
2=Fair
3=Good
4=Very Good
5=Excellent
How well your medical concerns were addressed by physician:
1=Poor
2=Fair
3=Good
4=Very Good
5=Excellent
Timeliness of returned phone calls by office staff:
1=Poor
2=Fair
3=Good
4=Very Good
5=Excellent
Ease of surgery scheduling (if applicable):
1=Poor
2=Fair
3=Good
4=Very Good
5=Excellent
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?:
Make it easier to get an appointment
Waiting time
Friendlier physicians
Friendlier staff
Improved parking
Telephone answering
Understanding my medical resume
None
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.
Name:
Phone:
E-mail:
Usage Agreement
We are looking for patient testimonials to further enhance our patient experience:
Yes, allow Peak Orthopedics & Spine to publicly share your anonymous survey information.
No, do not share my survey information for marketing purposes.
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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PGA Colorado Section
Arthritis Foundation Rocky Vista University Sky Ridge Medical Center AAHKS
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Reach Us Our Locations
Map 14100 E. Arapahoe Road Suite #370
Centennial, CO 80112
Phone: 303.699.PEAK (7325) |
Fax: 303.699.5486
E-mail Us
Map (Mailing Address)
9777 S. Yosemite Street Suite #220
Lone Tree, CO 80124

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