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| Please tell us about your doctor so that we can create an informative, comprehensive database to share with your AVN peers. For boxes with pre-printed text, just highlight the text and type over it. |
| Your Email address ( Required; you must be an organization member) |
| 1. What is the first and last name of your orthopedic doctor? |
| 2. For what institute does your doctor work? |
| 3. In what city and state is your doctor located? |
| 4. In what joint(s) does (do) your doctor specialize? |
| For statements 5-11, rate your doctor by clicking on just one selection (it will remain highlighted) |
| 5. My doctor seems to be knowledgeable about AVN. |
| 6. My doctor seems to be knowledgeable about current AVN treatments. |
| 7. My doctor seems to want to take an active (aggressive) role in treating my AVN. |
| 8. My doctor believes me when I tell him/her that I am in pain. |
| 9. My doctor treats me with respect. |
| 10. My doctor is willing to explain my diagnosis and treatment options with me; he takes his time in answering my questions. |
| 11. My doctor's staff is competent, friendly and helpful. |
| For questions 12 - 14, please tell us about your experience with your doctor appointments. |
| 12. The average wait time to get an appointment is |
| 13. The average wait time to be seen at your appointment is: |
| Please tell us anything else that you think we should know about your doctor or appointments. |
Thank you for taking our survey. Your answers will be useful for other AVN patients
who are organization members, and who are seeking experienced, knowledgeable
doctors to treat them, Please note that this survey is completely anonymous, you do
not have to give your own personal information. As we gather this data we will create
a Doctor Database and make it accessible to all Association members only. See
notation on this project on our Post Scripts page.
Please remember to click on the "Send" button; your survey will be automatically
sent to our office. If you wish to completely start over, just hit the "Reset" button and
fill it out again, then hit "Send."
Box 118 8500 Henry Ave.
Philadelphia, PA 19128
267-235-8750
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