Injured Employee Network Satisfaction Survey


Thank you for your time!

  • Name * Required

  • Date of Birth
  • Treating Doctor Name

  • Please provide any additional feedback which may be utilized to improve our services in the space provided below. We appreciate your efforts & participation in the IMO Med-Select Network®.

  • 1. Your ability to set an appointment was easy and within an acceptable timeframe
  • 2. Your wait time was not an extended amount of time and you were taken into the exam room within a reasonable timeframe of your arrival to the appointment
  • 3. Your treating doctor took your medical condition seriously and treated you with respect
  • 4. Your treating doctor did a thorough exam
  • 5. Your treating doctor provided answers to all of your questions
  • 6. Your treating doctor explained your medical condition with terms you were able to understand
  • 7. Your treating doctor discussed safe return to work
  • 8. Your treating doctor provided excellent medical care that met your needs and expectations
  • 9. The medical care you received was above average in comparison to medical care you have received in the past when injured or sick
  • 10. Overall, you were satisfied with the quality and timeliness of the medical care you received