Patient Delivery Survey
Westlake Orthotics and Prosthetics strives to provide the best care possible to you, as a patient! Your experience with us is very important. Please let us know how we did and/or how we can improve.
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Patient Name and DOB *
Who did you see today *
Did you receive your device on the date and time promised? *
How would you rate the comfort and initial fit of the device during your appointment? *
Did your provider make necessary adjustments to the device before you left? *
How well did your provider explain how to wear, break in, and care for your new device? *
Please rate the professionalism, care, and attention you received from your practitioner: *
How likely are you to recommend our clinic to a friend or family member? Scale: 0 (Not at all likely) to 5 (Extremely likely) 
 *
Would you like us to contact you? If so, please provide your name and phone number. *
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