Office Visits Survey

^-A ⁺A

P -- Poor F -- Fair G -- Good VG -- Very Good E -- Excellent

Type of Visit:

First visit for an injury or illness

Follow-up visit

Treatment for injury or illness

Surgical treatment

What did you like best about your visit to our office?

What did you like least about our office? How can we improve?

Please tell us about yourself

Sex

Male

Female

Age

Where do you live? (City & State)

Your doctor today was:

How did you hear about Lewiston Orthopaedics?

Other: (please list)

Who can we thank for referring you to our practice?

What most influenced your decision to choose Lewiston Orthopaedics?

Referral from doctor

Reputation of our doctors in the community

Reputation of our doctors for supporting community youth and local athletics

Other: (please list)

CAPTCHA

This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.

Please Note: Any information submitted using this form is transmitted securely and held in the strictest of confidence, protecting your privacy.

Search form