Patient Satisfaction Survey

Commonwealth Orthopaedic Centers and staff continuously strive to provide optimum care to our patients. In order to achieve this goal and to better serve our patients, your completion of this questionnaire is greatly appreciated. For each question below, place a check in the apropriate box and then submit the form to our office via our online system. Your answers will remain confidential and will not impact your care. This information will help to improve our service.

Date of Last Visit:

Location of Last Visit:

560 South Loop Rd. Edgewood, KY 41017
(859) 301-BONE
2845 Chancellor Dr.
(859) 426-4200
525 Alexandria Pike
(859) 301-BONE

Provider Last Seen

James D. Baker, MD
John D. Bever, MD
James T. Bilbo, MD
Matthew J. Connolly, DPM
Matthew T. DesJardins, MD
Thomas M. Due, MD
Nicholas T. Gates, MD
Michael A. Grefer, MD
Matthew S. Grunkemeyer, MD
Forest T. Heis, MD
Richard M. Hoblitzell, MD
Bruce R. Holladay, MD
Matthew T. Hummel, MD
John L. Larkin, MD
Michael D. O'Brien, MD
Avery Kondik, PA-C
Gary Hackett, PA-C
Nicholas Mai, ARNP
Jennifer Hensley, ARNP

	Poor	Fair	Good	Very Good	Excellent
Ability to get a timely appointment
Convenience of the office location
The manner in which you were treated by the front desk and/or other non-medical staff
The manner in which you were treated by the Medical Assistant who took you to the exam room.
The amount of time spent with your provider.
The provider's explanation of your condition and treatment
The appearance/cleanliness of the office
Overall experience with our practice

How long did you wait to see your provider?	0-15 min. 15-30 min. 30-45 min. 45-60 min. More than 60 min.
Would you recommend Commonwealth Orthopaedic Centers to your friends & family?	Very Likely Somewhat Likely Not sure Somewhat Unlikely Not Liikely At All

If anything about today's visit could be improved, what would it be?
(Check all that appy)
Nothing Better Parking
Friendlier Staff Easier to make an appointment
Appearance of the staff Less wait time to see provider
Friendlier Physicians More information about my condition/treatment
Other:

Suggestions or comments:

Name (Optional):

May we contact you?

Yes No

Phone Number:

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enter your email address* below.

* Commonwealth Orthopaedic Centers (COC) respects your privacy. Your email address is strictly used for this survey and is not recorded. COC will never trade, sell, or solicit your email to any third parties.

Legal Disclaimer:
The information presented in this site is for educational purposes only. It should not be used as a substitute for professional medical advice, or as the basis for medical diagnosis or treatment of a specific condition. Commonwealth Orthopeadics is not liable for any action taken or not taken in reliance on the information presented in this site.

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