Patient Survey

Request Appointment

Let us know how we did!

This field is for validation purposes and should be left unchanged.
Name(Required)
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? *(Required)
2. Have all office staff members been courteous and helpful? *(Required)
3. Were your benefits adequately explained to you? *(Required)
4. Have the office and treatment areas always been clean and comfortable? *(Required)
5. Did the clinic have scheduled appointments at convenient times for you? *(Required)
6. Was it easy to schedule your appointments? *(Required)
7. Were you always seen promptly when you arrived for treatment? *(Required)
8. Was the check-in process prompt and efficient? *(Required)
9. Was your therapist courteous and helpful? *(Required)
10. Did your physician/therapist fully explain your problem and how they would treat it? *(Required)
11. Did you receive a home program and were you instructed properly in activities to do at home? *(Required)
12. Would you recommend this facility to your friends or family? *(Required)
13. Will you return to our practice if future care is needed? *(Required)
14. How was your overall satisfaction with your experience in therapy? *(Required)