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Patient Survey



Your opinions and feelings are important to us.

The physicians and staff of Alabama Orthopaedic Clinic are dedicated to giving you the highest quality medical care and the best possible personal attention. Please take a moment to complete this questionnaire to help us serve you better!

General Information


Your opinions and feelings are important to us.

The physicians and staff of Alabama Orthopaedic Clinic are dedicated to giving you the highest quality medical care and
the best possible personal attention. Please take a moment to complete this questionnaire to help us serve you better!
General Information
Todays Date
mm/dd/yy
Appointment Time:
AM PM
Who is your physician?
How did you hear about us?
If other, please explain:
Did you find our office location convenient?
Comment:
Did we have adequate parking available?
Comment:
Did you find our waiting area to be comfortable?
Comment:
AOC Staff
Please select the number that best describes your response.
1 - Never
2 - Not all of the time 
3 - Sometimes 
4 - Most of the time  
5 - Always
N/A - Not Applicable.     
 
How were you greeted on your initial phone call?
1 2 3 4 5 N/A
Comment:
Did you find it easy to schedule an appointment in a timely manner?
1 2 3 4 5 N/A
Comment:
Did you find the front desk staff to be courteous and helpful?
1 2 3 4 5 N/A
Comment:
Please rate your wait time upon arrival to our office to see your physician?
1 2 3 4 5 N/A
Comment:
Was the nursing staff responsive and considerate of your needs?
1 2 3 4 5 N/A
Comment:
Were your phone calls returned in a prompt and professional manner?
1 2 3 4 5 N/A
Comment:
Was the x-ray staff courteous & responsive to your needs?
1 2 3 4 5 N/A
Comment:
Did your physician carefully explain diagnosis, treatment and follow-up instructions to you?
1 2 3 4 5 N/A
Comment:
Did your physician spend adequate time with you during your visit?
1 2 3 4 5 N/A
Comment:
Was our Business Office Representative professional and courteous in handling your needs?
1 2 3 4 5 N/A
If no, please explain:
Overall
Do you believe you received the highest quality of care from your physician?
1 2 3 4 5 N/A
Comment:
How would you rate your overall experience and quality of care provided by AOC?
1 2 3 4 5 N/A
Comment:
If you attended physical therapy, please rate your overall experience.
1 2 3 4 5 N/A
Comment:
Would you recommend AOC to your family and friends?
If no, please explain:
Do you have any recommendations on how we might serve you better?
Overall Comments:
May we contact you regarding your responses to this survey? Yes No
Optional Information
Name:
Address:
Phone:
email:
 example: yourname@domain.com
Occasionally,AOC physicians offer free seminars to our patients and the community regarding
orthopaedic topics and medical procedures.Would you like to be added to our mailing list so you
will receive an invitation to our free seminars?		 Yes No