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Patient Satisfaction Survey
We are committed to providing the best care possible to each and every one of our patients. Please take a few moments to complete the following survey:
1
. In which location did you receive care?
In which location did you receive care?
Burlingame: 1633 Bayshore Highway
Foster City: Peninsula Jewish Community Center
Los Gatos: Addison Penzak Jewish Community Center
San Jose: 2145 The Alameda
San Jose: Club One Almaden Valley
San Jose: Silver Creek Sportsplex
Stanford: Vaden Student Health Center
2
. Who was your primary treating therapist? (choose one only)
Who was your primary treating therapist? (choose one only)
Angie Traverso
Ashwini Velankar
Casey Olsen
Cher Kooiman
Chris Kuhn
Emily Schulz
Hilary Genise
Jaci Lee
Kate Scott
Kaylene Kaminski
Kelly Deala
Marci Stevenson
Martha Lepow
Melissa Stahl
Pooja Chokshi
Ron Kaminski
Stephanie Adams
Tina Nelms
Vince Gutierrez
Zaldy De La Cuesta
3
. How or from Whom did you first hear of MORE Physical Therapy, Inc.?
How or from Whom did you first hear of MORE Physical Therapy, Inc.?
Silver Creek Sportsplex
Physician
Word of Mouth
Club One
I am a returning patient
Insurance List
Santa Clara University
Stanford University
Jewish Community Center
MORE Website
Other (please specify)
4
. The therapists were professional and knowledgeable.
The therapists were professional and knowledgeable.
Agree
Neutral
Disagree
5
. My expectations for recovery are being met.
My expectations for recovery are being met.
Yes
Somewhat
No
6
. I have been properly educated in injury prevention and symptom control.
I have been properly educated in injury prevention and symptom control.
Agree
Neutral
Disagree
7
. If you have discontinued treatment please explain why
If you have discontinued treatment please explain why
Not Applicable
Released by Physician
Time Limitations
Released by Therapist
Transferred to another physical therapy provider
Insurance Coverage Exhausted
Moving out of the area
Other (please specify)
8
. Appointments are available at convenient times.
Appointments are available at convenient times.
Agree
Neutral
Disagree
9
. The reception staff is courteous and helpful.
The reception staff is courteous and helpful.
Agree
Neutral
Disagree
10
. The billing office staff is courteous and helpful.
The billing office staff is courteous and helpful.
Agree
Neutral
Disagree
N/A
11
. The therapy aides are courteous and helpful.
The therapy aides are courteous and helpful.
Agree
Neutral
Disagree
12
. The clinic is clean.
The clinic is clean.
Yes
Somewhat
No
13
. I am typically seen by my therapist within 15 minutes of my scheduled appointment.
I am typically seen by my therapist within 15 minutes of my scheduled appointment.
Regularly
Sometimes
Rarely
14
. I have been instructed in a thorough home exercise program that I understand.
I have been instructed in a thorough home exercise program that I understand.
Agree
Neutral
Disagree
15
. I have been given access to WebExercises, an internet based home exercise program.
I have been given access to WebExercises, an internet based home exercise program.
Yes
No
I was given written instructions with photographs of my home exercise program
16
. I will tell my referring doctor that:
I will tell my referring doctor that:
My experience was exceptional and I encourage him or her to continue sending their patients to MORE Physical Therapy, Inc.
My expectations were met and my experience was satisfactory.
My expectations were not met and my experience was less than satisfactory.
17
. Comments, kudos or constructive criticism:
Comments, kudos or constructive criticism:
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