Patient Survey

We value your opinion

At Snell Prosthetics & Orthotics, our professional staff constantly strives to improve the services we provide to our patients. That’s why Snell wants to hear from you. We need feedback from you, our client, to know when we’re exceeding your expectations and when there is room for improvement. Therefore, we’d appreciate it if you could take a few minutes to complete this brief survey.

Patient Survey

Other Location

Age

Sex

Approximate date of most recent visit:

Type of product(s) Snell provided for you: *

Other Product

2. How did you first hear about Snell Prosthetics & Orthotics? *

Other (How did you hear about us)

3. How would you assess the quality of service provided by the people at the front window? *

Excellent

Satisfactory

Unsatisfactory

4. Were the patient waiting and treatment areas clean and well-maintained? *

Yes

5. Did the staff member who fit your device treat you with courtesy and professionalism? *

Yes

6. Was your item(s) completed and delivered in a timely fashion? *

Yes

7. Were you completely satisfied with the fit and workmanship of the item(s) that you received? *

Yes

8. Did the staff member give you sufficient instructions or advice about wearing and caring for the item(s) you received? *

Yes

9. In your opinion, did the staff member seem competent in his or her skills? *

Yes

10. Overall, how would you assess your level of satisfaction with the service that Snell provided? *

11. Would you return to Snell if our services were needed again? *

Yes

If no, why not?

12. Would you recommend Snell to someone who needed our services? *

Yes

13. Have you visited our company’s website (SnellArkansas.com) within the past year? *

Yes

14. Please share any additional comments, suggestions or observations with us below:

Annual Drawing

Check here and provide your name and email address (optional) if you’d like to be entered into our annual $100 Walmart gift card drawing held each December.

Name

First Name

Last Name

Email Address

By providing the above information, you consent to receive future communications from Snell Prosthetics & Orthotics via email including, but not limited to,
appointment reminders, company information, and updates. We will never share your information with others and you can unsubscribe at any time.

Other (Social Media)

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Patient Survey

We value your opinion

SNELL PROSTHETICS & ORTHOTICS IS CERTIFIED AND ACCREDITED BY THE AMERICAN BOARD FOR CERTIFICATION AND THE BOARD OF CERTIFICATION/ACCREDITATION AND ALL OF OUR PRACTITIONERS ARE LICENSED BY THE STATE OF ARKANSAS

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