Questions About the Practice & Staff


During my visit, the staff treated me with courtesy and respect.
Choose one of the following answers

The staff was accessible & helpful to me.
Choose one of the following answers

Questions About Your Interaction with Your Provider


Which provider did you have a visit with?
Choose one of the following answers

During my visit, the provider treated me with courtesy and respect.
Choose one of the following answers

The provider spent a sufficient amount of time with me.
Choose one of the following answers

The provider clearly explained my diagnosis & treatment plan.


Choose one of the following answers

I have confidence in the provider’s level of knowledge and expertise.
Choose one of the following answers

I am satisfied with the way the provider treated my condition.
Choose one of the following answers

Based on my visit(s), I would stay with Performance Orthopaedics.
Choose one of the following answers

I would recommend Performance Orthopaedics to my friends and family.
Choose one of the following answers

Using any number from 0 to 10, where 0 is the worst provider possible and 10 is the best provider possible, what number would you use to rate your provider?
  1 2 3 4 5 6 7 8 9 10
Please tell us about anything that was done well, or anything that could have improved the care and services you received at your visit.

Name (Optional)