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UVA Orthopaedics Patient Survey
We strive to provide our patients with outstanding care and welcome your feedback about the care you received with us. Please take a few minutes to complete and submit this survey so that we can continue to improve your experience with UVA Orthopaedics. Your responses are voluntary and anonymous and you may complete this form more than once.
If you would like someone to contact you about this survey, please leave your contact information in the spaces provided.
Physician/Physician Assistant's Name
*
How satisfied are you with the following?
Extremely Dissatisfied
Very Dissatisfied
Satisfied
Very Satisfied
Extremely Satisfied
Ease of making appointments?
Our clinic's convenience (location, parks, layout etc)
Waiting time in clinic?
Friendliness/Helpfulness of staff?
Medical care received from your physician or physician assistant?
Overall impression of the clinic?
If you had surgery
University Hospital
Outpatient Surgery Center
Location of Surgery
Please complete the following questions if you had surgery. How satisfied are you with the following?
Extremely Dissatisfied
Very Dissatisfied
Satisfied
Very Satisfied
Extremely Satisfied
Ease of surgical scheduling?
Pre-operative teaching provided in clinic?
Our hospital or surgery center's convenience (location, parking, facilities)?
Day of surgery experience?
Post-operative instructions?
Post-operative pain control?
Overall impression of the surgery?
Definitely Would Not
Probably Would Not
Not Sure
Probably Would
Definitely Would
Would you recommend your doctor to your family or friends?
Comments:
Thank you for your comments. Please check this box if we may use your comments anonymously.
Please provide your name and phone number or email address if you would like someone to contact you.
Yes, you may use my comments
Name
First
Last
Phone
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Email
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