We are extremely interested in your thoughts about how you choose your  prosthetist. This survey is anonymous and will be used for assessment within the Prosthetic and Orthotic Profession. Please respond honestly to the following questions.
 
THIS DATA IS NOT BEING COMPILED FOR SALE! A summary of responses will be displayed upon completion.
 
Thank you for your participation,
 
Scott Williamson
1.
 When you think of your IDEAL prosthetic facility, how important are each of these charactistics to you? Please rank the importance of each response below by marking the appropriate box.  Please use each column only ONCE.  
 Most Important 2 3 4 5 6 Least Important
Positive, friendly staff
Relaxing environment
Easy access (parking, entry, etc)
Comfortable waiting area
Encouraging artwork, images
Safe environment
Clean facility
2.
 When you think of your IDEAL prosthetist, how important are each of these charactistics to you? Please rank the importance of each response below by marking the appropriate box.  Please use each column only ONCE. 
 Most Important 2 3 4 5 6 Least Important
A Resource/Partner in my health
Good at what they do
Responsive to me
Understands my needs
Communicates well with me
Dependable
Get it right the first time
3.
Is there anything else you would like us to consider that we have not covered here?
Comment:
4.
On which limb(s) do you wear a prosthesis? (select all that apply)
5.
Please tell us about yourself.
Gender
Birth Date:
How long ago did you have your (first) amputation?
Mark the box if you have had more than one amputation?