1	Who is your physician at Southern Arizona Orthopedics? R. Wayne Wood, MD R. Mark Blew, MD Robert C. Kersey, MD Timothy B. Dixon, MD Jerome K. Steck DPM George R. Bradbury, MD

2	Would you recommend your physician to family/friends? 1 2 3 4 5

3	Do you trust your physician to make decisions/recommendations that are in your best interests? 1 2 3 4 5

4	Does the physician help you understand your medical condition(s)? 1 2 3 4 5

5	Does the physician listen to you and answer your questions? 1 2 3 4 5

6	Do you feel the physician spends an appropriate amount of time with you? 1 2 3 4 5

7	Ease of scheduling urgent appointments when you feel ill: 1 2 3 4 5

8	Office environment (cleanliness, comfort, lighting, temperature, location): 1 2 3 4 5

9	Friendliness and courtesy of the office staff: 1 2 3 4 5

10	Once you arrive for a scheduled appointment, how long do you have to wait (including lobby and exam room) before you see this physician: Over 45 min. 31 - 45 min. 16 - 30 min. 10 - 15 min. under 10 min.

11	Comments?

12	Name Address 1 Address 2 City/Town State/Province Zip/Postal Code Email Address