Our goal is to improve our services to you! P -- Poor F -- Fair G -- Good VG -- Very Good E -- Excellent Please rate each of the following by marking your response: How long you waited to get an appointment P F G VG E Getting through to the office by phone P F G VG E Length of time waiting at the office P F G VG E Convenience of the office location P F G VG E Time spent with the doctor P F G VG E Explanation of what was done for you P F G VG E The technical skills of the doctor you saw P F G VG E (thoroughness, carefulness, competence) The personal manner of the doctor you saw P F G VG E (courtesy, respect, sensitivity, friendliness) The personal manner of the nurses and X-ray staff P F G VG E (courtesy, respect, sensitivity, friendliness) The personal manner of the front desk and staff P F G VG E (courtesy, respect, sensitivity, friendliness) The visit overall P F G VG E Value of overall medical care during the visit P F G VG E What is the likelihood that you would recommend us to family and friends? P F G VG E 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: No ValueBryan J. Beardsley, M.D.DeWayne L. Weaver, M.D.Gregory D. Dietrich, M.D.J. Adam Jelinek, M.D.OtherRegan B. Hansen, M.D.Steven R. Boyea, M.D.Timothy J. Flock, M.D. How did you hear about Lewiston Orthopaedics? Referral from doctor Recommendation from friend or family Reputation in the community Yellow Pages Radio ads 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) CAPTCHAThis question is for testing whether or not you are a human visitor and to prevent automated spam submissions. Math question * 5 + 1 = Solve this simple math problem and enter the result. E.g. for 1+3, enter 4. Submit Please Note: Any information submitted using this form is transmitted securely and held in the strictest of confidence, protecting your privacy.
