Patient Survey

Thank you for visiting Palm Beach Orthopaedic Institute. We value feedback about your experience so we can provide you with the best service possible. Please complete and submit our Patient Satisfaction Survey below.

Name*
FirstLast
Email*
Phone
Address
Street AddressAddress Line 2CityState / Province / RegionZip / Postal CodeCountry
Patient Type:
- New Patient
- Established Patient
Office visited:*
Date of visit:
Provider:*
How did you hear about PBOI?
- Attorney
- Commercial
- ER
- First Available
- Friends/Neighbors
- Hospital
- Internet
- Magazine
- Magazine (Jupiter)
- Magazine (Wellington)
- Newspaper
- Newspaper (LaPalma)
- Newspaper (Palm Beach Post)
- Newspaper (Palm Beacher)
- Newspaper (Town Crier)
- Patient Referrals
- Requested Location
- Requested Physician
- Returning Patient
- School
- Seminar
- Urgent Care
- Work Comp
Is there a staff member who "knocked your socks off" with service today?
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1) I will likely recommend PBOI to a friend/neighbor.*
- Strongly agree
- Moderately agree
- Undecided
- Moderately disagree
- Strongly disagree
2) Overall, my experience today was…*
- Excellent. We truly provided 5-Star Service.
- Very Good. We met your expectations and went beyond.
- Good. We met your expectations.
- Fair. We came close, but did not meet your expectations.
- Poor. We did not meet your minimum expectations.
3) Overall, the cleanliness of our office was…*
- Excellent. We truly provided 5-Star Service.
- Very Good. We met your expectations and went beyond.
- Good. We met your expectations.
- Fair. We came close, but did not meet your expectations.
- Poor. We did not meet your minimum expectations.
4) I was able to schedule my appointment within a reasonable time frame.*
- Strongly agree
- Moderately agree
- Undecided
- Moderately disagree
- Strongly disagree
5) The phone staff was professional and friendly.*
- Strongly agree
- Moderately agree
- Undecided
- Moderately disagree
- Strongly disagree
6) The front desk staff was efficient and friendly.*
- Strongly agree
- Moderately agree
- Undecided
- Moderately disagree
- Strongly disagree
7) The nursing staff was knowledgeable, professional, and friendly.*
- Strongly agree
- Moderately agree
- Undecided
- Moderately disagree
- Strongly disagree
8) The x-ray staff was knowledgeable, professional, and friendly.*
- Strongly agree
- Moderately agree
- Undecided
- Moderately disagree
- Strongly disagree
9) I received care, concern and respect from my provider.*
- Strongly agree
- Moderately agree
- Undecided
- Moderately disagree
- Strongly disagree
10) I received clear and complete communication from my provider.*
- Strongly agree
- Moderately agree
- Undecided
- Moderately disagree
- Strongly disagree
11) I found the PBOI website to be efficient and helpful.*
- Strongly agree
- Moderately agree
- Undecided
- Moderately disagree
- Strongly disagree
12) Receiving an appointment reminder call was helpful. *
- Strongly agree
- Moderately agree
- Undecided
- Moderately disagree
- Strongly disagree
What did we do well today?
What can we do better in the future?
Other comments:

Patient Survey

Patient Survey

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