Patient Survey

*=Required Field

* Established Patient New Patient
Please choose one.

* Office Visited:
Please Select One El Dorado East Wichita West Wichita Derby

* Date of Visit

* Provider:
Please Select One Pat Do, MD ~ Orthopedic Surgeon David Hufford, MD ~ Orthopedic Surgeon John R. Babb, MD ~ Orthopedic Surgeon Samuel M. Bourn, MD ~ Spine Surgeon Justin Strickland, MD ~ Orthopedic Surgeon

How did you hear about MAO?
Dr. Referral
Friend/Family
Google
Lawyer
Prior Experience
Radio
Rascals
Yellow Pages (Book)
Yellowpages.com
Trainer

Is there a staff member who "knocked your socks off" with service today?

Please take a moment to "stay connected" by rating our service during your visit.

5 = Excellent. We truly provided 5-Star Service.
4 = Very Good. We met your expectations and went beyond.
3 = Good. We met your expectations.
2 = Fair. We came close, but did not meet your expectations.
1 = Poor. We did not meet your minimum expectations.
N/A

* 1. I will likely recommend MAO to a friend/neighbor.
1 2 3 4 5 N/A
Please choose one.

* 2. My overall experience was...
1 2 3 4 5 N/A
Please choose one.

* 3. I was able to schedule my appointment within a reasonable time frame.
1 2 3 4 5 N/A
Please choose one.

* 4. The phone staff was professional and friendly.
1 2 3 4 5 N/A
Please choose one.

* 5. The check-in staff was efficient and friendly.
1 2 3 4 5 N/A
Please choose one.

* 6. The nursing staff was knowledegable, professional, and friendly.
1 2 3 4 5 N/A
Please choose one.

* 7. MRI or DME staff was knowledgeable, professional, and friendly.
1 2 3 4 5 N/A
Please choose one.

* 8. The billing staff was knowledgeable, professional, and friendly.
1 2 3 4 5 N/A
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* 9. I recieved care, concern, and respect from my provider
1 2 3 4 5 N/A
Please choose one.

* 10. Receiving a reminder call or email was helpful.
1 2 3 4 5 N/A
Please choose one.

* What did we do well today?

* What can we do better inthe future?

* Name

*Address

* Phone

* Email

* Security Code