Patient Survey

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Name*
Please rate the survey questions below based on the following scale. N/A = Not Applicable 1 = Unsatisfactory 2 = Fair 3 = Average 4 = Good 5 = Excellent
1. Was our staff friendly and helpful on the phone with you? **
2. Have all office staff members been courteous and helpful? **
3. Were your benefits adequately explained to you? **
4. Have the office and treatment areas always been clean and comfortable? **
5. Did the clinic have scheduled appointments at convenient times for you? **
6. Was it easy to schedule your appointments? **
7. Were you always seen promptly when you arrived for treatment? **
8. Was the check-in process prompt and efficient? **
9. Was your therapist courteous and helpful? **
10. Did your physician/therapist fully explain your problem and how they would treat it? **
11. Did you receive a home program and were you instructed properly in activities to do at home? **
12. Would you recommend this facility to your friends or family? **
13. Will you return to our practice if future care is needed? **
14. How was your overall satisfaction with your experience in therapy? **