Step 1 of 5 0% OrganisationOrganisation*Discreet call and pick up; a smooth and straightforward processes; sensitive handling of you as a patient and your personal data. excellentvery goodgoodacceptablepoorRegular Clarification*Permanent clarification about attending/treating physician and caregivers, as well as information about the to be performed activities, its reasons and estimated expenditure of time.excellentvery goodgoodacceptablepoorpage 1 of 5 Examination and medical care In the context of your first visit, examinations and/ or consultations are performed. Please remember/think of the execution of the examination and consultation, as well as the explanation of your diagnose, within this section. Examination and Diagnose*Professional and detailed examination; comprehensible and detailed explanation of the diagnose and its possible effects. excellentvery goodgoodacceptablepoorConsultation*Comprehensible and complete advice; demonstration of treatment options, risks, as well as healing opportunities; Clarification about implications (medicine, pain, restrictions in daily routine, duration of treatment and recovery) excellentvery goodgoodacceptablepoorAppreciation and respond to you as patient*Familial, individual contact; cooperativeness and geniality/ kindness; listening and responding to the patients worries, fears and desires in an honest and sensitive way. excellentvery goodgoodacceptablepoorpage 2 of 5 FinancingCosts*Did you get informed about the amount of the expectable costs (retention) in time? Was the estimate of costs transparent and comprehensible? Was there the willing to find a solution at optimal costs for you?excellentvery goodgoodacceptablepoorStatus of insurance* compulsory insurance private insurance travel insurance supplementary insurance Name of the insurance (not obligatory)page 3 of 5 Success of treatment & overall satisfactionSuccess of the treatment*excellentvery goodgoodacceptablepoorOverall satisfaction*excellentvery goodgoodacceptablepoorpage 4 of 5 General InformationHow did you find us? Who told you about us? (please choose below)*It was an emergency (I was brought by ambulance/ emergency doctor)Referral through a physicianRecommend by relatives/ friendsI have heard/ read about the Unfallpraxis in the (local) media.Telephone book, business directoryInternet, physician tracing service, social mediaThrough personal connection to the Unfallpraxis or. to an employee of the UnfallpraxisMediation/ recommendation by my (compulsory) health insuranceMediation/ recommendation by the hotel/ hostel staffothersThe availability on the telephone is:excellentvery goodgoodacceptablepoorThe communicating via e-mail is:excellentvery goodgoodacceptablepoordate of treatment (not obligatory) Date Format: DD slash MM slash YYYY Frequency of the visits*Please let us know how many times you needed to come and visit our hospital in person, during the duration of your treatment. only 1 appointment was necessary2 appointments were necessary3 appointments were necessary4 appointments were necessarymore than 4 appointments were necessarygender (not obligatory)malefemaleage (not obligatory)Keine AngabeBis 1920-2425-2930-3435-3940-4445-4950-5455-59Über 60postal code (not obligatory)place of residence (not obligatory)Would you like to inform us about something else?E-Mail (not obligatory) * Yes, I do agree that my data will be transmitted, processed and stored as part of this survey. page 5 of 5CommentsThis field is for validation purposes and should be left unchanged. This iframe contains the logic required to handle Ajax powered Gravity Forms.