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Patient Satisfaction Survey

1. Overall impression of our facility *

Very Satisfied Satisfied Neutral Unsatisfied Very Unsatisfied

2. Communication with our staff, both on the telephone and in person *

Very Satisfied Satisfied Neutral Unsatisfied Very Unsatisfied

3. Waiting times for scheduling appointments and for being seen at the time of your appointment in the clinic *

Very Satisfied Satisfied Neutral Unsatisfied Very Unsatisfied

4. Explanation of clinic paper work and your financial obligations for therapy services *

Very Satisfied Satisfied Neutral Unsatisfied Very Unsatisfied

5. Clincial staff's courteousness, professionalism, and respect for your privacy/confidentiality *

Very Satisfied Satisfied Neutral Unsatisfied Very Unsatisfied

6. Therapist's willingness and ability to clearly answer your questions *

Very Satisfied Satisfied Neutral Unsatisfied Very Unsatisfied

7. Therapists understanding of your condition *

Very Satisfied Satisfied Neutral Unsatisfied Very Unsatisfied

8. Your confidence in the therapist's ability to perform a thorough examination, accurately evaluate you condition, and provide appropriate treatment *

Very Satisfied Satisfied Neutral Unsatisfied Very Unsatisfied

9. Therapist's explanation of home exercise program and what you should expect after discharge from therapy *

Very Satisfied Satisfied Neutral Unsatisfied Very Unsatisfied

10. Please rate your willingness to recommend this clinic to your family and friends if they need physical therapy *

Excellent Very Good Fair Poor Very Poor

Comments or Suggestions *

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