Satisfaction Survey

1044 XRay Dr Gastonia, NC 28054

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Kinetic O & P > Satisfaction Survey

Satisfaction Survey

If you would like to provide feedback about our staff and/or services, fill in the form below. Alternatively, you can download the form and email to [email protected]

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Patient Satisfaction Survey

In continuance without pursuit to provide you with the very best customer experience, please take a moment to fill out this survey. We greatly appreciate your feedback.

Patient Name

Date

Email

What type of device applicable to your most recent appointment:

Orthotic

Prosthetic

Practitioner Name

How do you rate the level of service you received?

1. Discussed and answered any questions*

Poor

Fair

Good

Excellent

2. Effectively resolved any issues*

Poor

Fair

Good

Excellent

3. Helpful, provided suggestions and fitting instructions*

Poor

Fair

Good

Excellent

4. Professional, Courteous, returned calls in timely manner*

Poor

Fair

Good

Excellent

5. Staff explained warranty & patient financial responsibility*

Poor

Fair

Good

Excellent

6. How Satisfied are you with your device & its function*

Poor

Fair

Good

Excellent

7. Did you receive your device in the time promised?*

Poor

Fair

Good

Excellent

Would you recommend Kinetic to a friend or colleague?

Yes

No

Based on your experience and on a scale of 1-4 ( 4 being the best) how would you rate Kinetic?

Please feel free to write any additional comments explaining your rating above:

Captcha

Kinetic O&P

704-691-7145 Fax: (704)691-7631

[email protected]

2571 Pembroke Road Gastonia, NC 28054

Hours

Monday 8.30 AM To 5.00 PM
tuesday 8.30 AM To 5.00 PM
wednesday 8.30 AM To 5.00 PM
thursday 8.30 AM To 5.00 PM
friday Closed
Saturday Closed
Sunday Closed