{"id":535,"date":"2016-08-11T18:31:26","date_gmt":"2016-08-11T18:31:26","guid":{"rendered":"http:\/\/healthcarewebsite.net\/bascharon\/?page_id=94"},"modified":"2021-02-10T00:10:49","modified_gmt":"2021-02-10T00:10:49","slug":"visit-survey","status":"publish","type":"page","link":"https:\/\/vegasortho.com\/patient\/visit-survey\/","title":{"rendered":"Post-Visit Patient Survey"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"535\" class=\"elementor elementor-535\" data-elementor-post-type=\"page\">\n\t\t\t\t\t\t<section class=\"has_ae_slider elementor-section elementor-top-section elementor-element elementor-element-e2d3b0c elementor-section-boxed elementor-section-height-default elementor-section-height-default ae-bg-gallery-type-default\" data-id=\"e2d3b0c\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"has_ae_slider elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-e635b98 ae-bg-gallery-type-default\" data-id=\"e635b98\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-74f0dff4 elementor-widget elementor-widget-text-editor\" data-id=\"74f0dff4\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<h2>Post-Visit Patient Survey for OSMILV.<\/h2><p>Tell us how we\u2019re doing! The Orthopedic &amp; Sports Medicine Institute of Las Vegas wants to ensure every experience you have with us is pleasurable and you are receiving the highest quality of care.<\/p><p>Please take a moment to complete our post-visit survey, so we can learn what we did right and how we can improve.<\/p><p><strong>[* Denotes required field]<\/strong><\/p>\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-22a76d1 eael-gravity-form-button-custom elementor-widget elementor-widget-eael-gravity-form\" data-id=\"22a76d1\" data-element_type=\"widget\" data-widget_type=\"eael-gravity-form.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t            <div class=\"eael-contact-form eael-gravity-form placeholder-hide eael-contact-form-align-default\">\n                                <script type=\"text\/javascript\">var 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gfield_visibility_visible\"  data-js-reload=\"field_4_13\" ><h2 class=\"gsection_title\">Patient Information<\/h2><\/li><li id=\"field_4_16\" class=\"gfield gfield--type-radio gfield--type-choice field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_4_16\" ><label class='gfield_label gform-field-label' >Would you like to remain anonymous?<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_4_16'>\n\t\t\t<li class='gchoice gchoice_4_16_0'>\n\t\t\t\t<input name='input_16' type='radio' value='No'  id='choice_4_16_0'    \/>\n\t\t\t\t<label for='choice_4_16_0' id='label_4_16_0' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_4_16_1'>\n\t\t\t\t<input name='input_16' type='radio' value='Yes'  id='choice_4_16_1'    \/>\n\t\t\t\t<label for='choice_4_16_1' id='label_4_16_1' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_4_2\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_4_2\" ><label class='gfield_label gform-field-label' for='input_4_2'>Full Name<\/label><div class='ginput_container ginput_container_text'><input name='input_2' id='input_4_2' type='text' value='' class='medium'    placeholder='Full Name'  aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_4_3\" class=\"gfield gfield--type-phone field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_4_3\" ><label class='gfield_label gform-field-label' for='input_4_3'>Phone<\/label><div class='ginput_container ginput_container_phone'><input name='input_3' id='input_4_3' type='tel' value='' class='medium'  placeholder='Phone'  aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_4_14\" class=\"gfield gfield--type-section gsection field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_4_14\" ><h2 class=\"gsection_title\">Doctor Information<\/h2><div class='gsection_description' id='gfield_description_4_14'>Doctor: Dr. Randa Bascharon<\/div><\/li><li id=\"field_4_6\" class=\"gfield gfield--type-select field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_4_6\" ><label class='gfield_label gform-field-label' for='input_4_6'>Location*<\/label><div class='ginput_container ginput_container_select'><select name='input_6' id='input_4_6' class='medium gfield_select'     aria-invalid=\"false\" ><option value='Sahara Avenue' >Sahara Avenue<\/option><option value='Windmill Lane' >Windmill Lane<\/option><option value='North Durango' >North Durango<\/option><\/select><\/div><\/li><li id=\"field_4_15\" class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_4_15\" ><h2 class=\"gsection_title\">Ratings<\/h2><\/li><li id=\"field_4_8\" class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_4_8\" ><label class='gfield_label gform-field-label' >How would you rate your experience in scheduling your appointment?<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_4_8'>\n\t\t\t<li class='gchoice gchoice_4_8_0'>\n\t\t\t\t<input name='input_8' type='radio' value='Excellent'  id='choice_4_8_0'    \/>\n\t\t\t\t<label for='choice_4_8_0' id='label_4_8_0' class='gform-field-label gform-field-label--type-inline'>Excellent<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_4_8_1'>\n\t\t\t\t<input name='input_8' type='radio' value='Good'  id='choice_4_8_1'    \/>\n\t\t\t\t<label for='choice_4_8_1' id='label_4_8_1' class='gform-field-label gform-field-label--type-inline'>Good<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_4_8_2'>\n\t\t\t\t<input name='input_8' type='radio' value='Average'  id='choice_4_8_2'    \/>\n\t\t\t\t<label for='choice_4_8_2' id='label_4_8_2' class='gform-field-label gform-field-label--type-inline'>Average<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_4_8_3'>\n\t\t\t\t<input name='input_8' type='radio' value='Fair'  id='choice_4_8_3'    \/>\n\t\t\t\t<label for='choice_4_8_3' id='label_4_8_3' class='gform-field-label gform-field-label--type-inline'>Fair<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_4_8_4'>\n\t\t\t\t<input name='input_8' type='radio' value='Poor'  id='choice_4_8_4'    \/>\n\t\t\t\t<label for='choice_4_8_4' id='label_4_8_4' class='gform-field-label gform-field-label--type-inline'>Poor<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_4_8_5'>\n\t\t\t\t<input name='input_8' type='radio' value='N\/A'  id='choice_4_8_5'    \/>\n\t\t\t\t<label for='choice_4_8_5' id='label_4_8_5' class='gform-field-label gform-field-label--type-inline'>N\/A<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_4_9\" class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_4_9\" ><label class='gfield_label gform-field-label' >How would you rate the cleanliness of our office and waiting room?<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_4_9'>\n\t\t\t<li class='gchoice gchoice_4_9_0'>\n\t\t\t\t<input name='input_9' type='radio' value='Excellent'  id='choice_4_9_0'    \/>\n\t\t\t\t<label for='choice_4_9_0' id='label_4_9_0' class='gform-field-label gform-field-label--type-inline'>Excellent<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_4_9_1'>\n\t\t\t\t<input name='input_9' type='radio' value='Good'  id='choice_4_9_1'    \/>\n\t\t\t\t<label for='choice_4_9_1' id='label_4_9_1' class='gform-field-label gform-field-label--type-inline'>Good<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_4_9_2'>\n\t\t\t\t<input name='input_9' type='radio' value='Average'  id='choice_4_9_2'    \/>\n\t\t\t\t<label for='choice_4_9_2' id='label_4_9_2' class='gform-field-label gform-field-label--type-inline'>Average<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_4_9_3'>\n\t\t\t\t<input name='input_9' type='radio' value='Fair'  id='choice_4_9_3'    \/>\n\t\t\t\t<label for='choice_4_9_3' id='label_4_9_3' class='gform-field-label gform-field-label--type-inline'>Fair<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_4_9_4'>\n\t\t\t\t<input name='input_9' type='radio' value='Poor'  id='choice_4_9_4'    \/>\n\t\t\t\t<label for='choice_4_9_4' id='label_4_9_4' class='gform-field-label gform-field-label--type-inline'>Poor<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_4_9_5'>\n\t\t\t\t<input name='input_9' type='radio' value='N\/A'  id='choice_4_9_5'    \/>\n\t\t\t\t<label for='choice_4_9_5' id='label_4_9_5' class='gform-field-label gform-field-label--type-inline'>N\/A<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_4_10\" class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_4_10\" ><label class='gfield_label gform-field-label' >How would you rate the friendliness of our staff?<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_4_10'>\n\t\t\t<li class='gchoice gchoice_4_10_0'>\n\t\t\t\t<input name='input_10' type='radio' value='Excellent'  id='choice_4_10_0'    \/>\n\t\t\t\t<label for='choice_4_10_0' id='label_4_10_0' class='gform-field-label gform-field-label--type-inline'>Excellent<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_4_10_1'>\n\t\t\t\t<input name='input_10' type='radio' value='Good'  id='choice_4_10_1'    \/>\n\t\t\t\t<label for='choice_4_10_1' id='label_4_10_1' class='gform-field-label gform-field-label--type-inline'>Good<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_4_10_2'>\n\t\t\t\t<input name='input_10' type='radio' value='Average'  id='choice_4_10_2'    \/>\n\t\t\t\t<label for='choice_4_10_2' id='label_4_10_2' class='gform-field-label gform-field-label--type-inline'>Average<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_4_10_3'>\n\t\t\t\t<input name='input_10' type='radio' value='Fair'  id='choice_4_10_3'    \/>\n\t\t\t\t<label for='choice_4_10_3' id='label_4_10_3' class='gform-field-label gform-field-label--type-inline'>Fair<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_4_10_4'>\n\t\t\t\t<input name='input_10' type='radio' value='Poor'  id='choice_4_10_4'    \/>\n\t\t\t\t<label for='choice_4_10_4' id='label_4_10_4' class='gform-field-label gform-field-label--type-inline'>Poor<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_4_10_5'>\n\t\t\t\t<input name='input_10' type='radio' value='N\/A'  id='choice_4_10_5'    \/>\n\t\t\t\t<label for='choice_4_10_5' id='label_4_10_5' class='gform-field-label gform-field-label--type-inline'>N\/A<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_4_11\" class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_4_11\" ><label class='gfield_label gform-field-label' >How would you rate the quality of care you received?<\/label><div class='ginput_container 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