Date Format: DD slash MM slash YYYY
Please check the percent improvement you experienced with treatment.
How soon were you able to make your first appointment?
Within 2 Days
Within 1 Week
Within 2 Weeks
Check the box that best describes your experience as it relates to the questions below.
The courtesy you experienced with our front office staff was?
Ease of scheduling?
The courtesy of our clinical staff was?
Explanation of your problem and how your therapist planned to help you?
Respect for my confidentiality/privacy?
Overall Quality of Care and Service?
What did we do well with your care? (please write your comments in the box below)
What could we have done better? (please write your comments in the box below)
Would you use us again?
Would you recommend us to a friend?
Receiving the Physical Therapy Professionals monthly newsletter on fitness, injury prevention, and physical therapy makes me more likely to use you in the future. (check the response that is most appropriate)
I don’t get your newsletter but would like to receive it.
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