Deprecated: mysql_connect(): The mysql extension is deprecated and will be removed in the future: use mysqli or PDO instead in /home/benjamindom/public_html/patient-survey.php on line 21

Share Your Story

Dr. Domb and his team strive to improve patient outcomes and satisfaction. Please take a moment to share your story and give us feedback.

(*) Fields Marked Are Mandatory
      • Poor
      • Fair
      • Good
      • Very Good
      • Excellent

  • (Allowed formats : 'gif', 'jpg', 'jpeg', 'png', 'docx', 'pdf', 'ppt', 'xls', 'xlsx')
  • Yes No
  • Learn more about the Survey
    Learn more about the Survey

    To ensure that we are holding ourselves to the highest standards, we partner with Your Practice Online (4590 MacArthur Blvd, Suite 500, Newport Beach, CA 92660, USA). Your Practice Online manages 1600+ websites for medical practices worldwide.

    Our mission is to provide the most advanced, world-class orthopedic medical and surgical care in a comfortable and caring environment. With that in mind, all patients are invited to complete the electronic survey on our website. Patients may complete the survey to provide rating and comments regarding their experience about specific aspects of their care. All feedback is completely confidential and is used to improve all aspects of the clinic experience. To date we have received (17) surveys We are committed to posting positive and negative feedback. Dr. Domb, however reserves the right not to post comments that are libelous, slanderous, profane or those that risk the privacy of our patients.