Satisfaction Survey

(704) 691-7145

tutt@kineticoandp.com

2571 Pembroke Rd 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 tutt@kineticoandp.com

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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

tutt@kineticoandp.com

2571 Pembroke Road Gastonia, NC 28054

Hours

Monday 8:30 AM To 3:00 PM
tuesday 8:30 AM To 3:00 PM
wednesday 8:30 AM To 3:00 PM
thursday 8:30 AM To 3:00 PM
friday Closed
Saturday Closed
Sunday Closed