Patient Experience Evaluation

You have been fit with an orthosis (brace) from our office and your satisfaction with our service is important to us. Please take a few minutes to complete the questionnaire so we may continue to provide outstanding care for YOU!

No need to roll your eyes 🙂

This survey helps us serve you better. We really do look at these!

You have been fit with an orthosis (brace) from our office and your satisfaction with our service is important to us.

Please take a few minutes to complete the questionnaire so we may continue to provide outstanding care for YOU!

Full Name *

Email *

Date Of Visit *

Practitioner

Type of Orthoses *

You found our office easy to locate? *

The waiting area was comfortable? *

Your wait time was a reasonable amount of time? *

The office staff was courteous to you? *

The office staff was able to answer your insurance questions promptly? *

The Orthotist/practitioner thoroughly explained the wearing instructions for your brace? *

You were educated about your condition and the brace(s)? *

You left Wolverine Orthotics, Inc. feeling you could contact the office i f you had questions and/or concerns? *

How satisfied are you with the success of the device you were fitted with? *

Did you have a scheduled appointment? *

Yes

Walk-in

Who told you about Wolverine Orthotics, Inc.?

Have you been to our web site, www.wolverineorthotics.com? *

Yes

Please consider providing a personal testimonial regarding your experience at Wolverine Orthotics, Inc. *

May we include your testimonial on our web site and/or our brochure? *

Yes

May we include your name along with your testimonial in print? *

Yes

Signature *

Clear

(248) 324-3010

(248) 324-3003

wolverineorthotics@gmail.com

Monday: 8 a.m. – 5 p.m.
Tuesday: 8 a.m. – 5 p.m.
Wednesday: 8 a.m. – 6 p.m.
Thursday: 8 a.m. – 5 p.m.
Friday: 8 a.m. – 5 p.m.
Saturday & Sunday: Closed