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 data. excellentvery goodgoodacceptablepoorRegular Clarification*Permanent clarification about attending physician and caregivers, as well as information about the to be performed activities, its reason 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 insurancepage 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?*It was an emergency (I was brought by ambulance/ emergency doctor/ helicopter)Referral through a physicianRecommend by relatives/ friendsI have heard/ read about Sportclinic Zillertal in the (local) media.Telephone book, business directoryInternet, physician tracing service, social mediaThrough personal connection to the sportclinic or. to an employee of the sportclincMediation/ recommendation by my (compulsory) health insuranceMediation/ recommendation by the staff of the mountain railway/ mountain rescueMediation/ recommendation by the hotel/ hostel staffotherThe availability on the telephone is:*excellentvery goodgoodacceptablepoorThe communicating via e-mail is:*excellentvery goodgoodacceptablepoordate of treatmentmonth123456789101112day12345678910111213141516171819202122232425262728293031year20202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Frequency 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 necessarygendermalefemaleageno statementunder or 1920-2425-2930-3435-3940-4445-4950-5455-59over 60postal codeplace of residenceWould you like to inform us about something else?E-Mail * Yes, I do agree that my data will be transmitted, processed and stored as part of this survey. page 5 of 5Ohne TitelErste AuswahlZweite AuswahlDritte AuswahlNameThis field is for validation purposes and should be left unchanged. This iframe contains the logic required to handle Ajax powered Gravity Forms.