Customer Survey
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1
. How did you hear about Skill Builders?
How did you hear about Skill Builders?
Doctor Referral
Word of Mouth
Print Ad
Yellow Pages
Internet
Other
2
. Please check off the services you have used:
Please check off the services you have used:
Physiotherapy
Occupational Therapy
Massage Therapy
Driving
3
. Were you pleased with our client services team and how they were able to accomodate your needs?
Extremely Satisfied
Satisfied
Dissatisfied
Greeted Courteously
*
Were you pleased with our client services team and how they were able to accomodate your needs? Greeted Courteously Extremely Satisfied
Greeted Courteously Satisfied
Greeted Courteously Dissatisfied
Booking Appointments
Booking Appointments Extremely Satisfied
Booking Appointments Satisfied
Booking Appointments Dissatisfied
4
. Were you treated with professionalism and respect by your therapist?
Extremely Satisfied
Satisfied
Dissatisfied
Greeted Courteously
*
Were you treated with professionalism and respect by your therapist? Greeted Courteously Extremely Satisfied
Greeted Courteously Satisfied
Greeted Courteously Dissatisfied
Treatment Clearly Explained
Treatment Clearly Explained Extremely Satisfied
Treatment Clearly Explained Satisfied
Treatment Clearly Explained Dissatisfied
5
. Were you satisfied with the cleanliness of the following?
Satisfied
Dissatisfied
Not Applicable
Gym
*
Were you satisfied with the cleanliness of the following? Gym Satisfied
Gym Dissatisfied
Gym Not Applicable
Treatment Room
Treatment Room Satisfied
Treatment Room Dissatisfied
Treatment Room Not Applicable
Washroom
Washroom Satisfied
Washroom Dissatisfied
Washroom Not Applicable
Waiting Room
Waiting Room Satisfied
Waiting Room Dissatisfied
Waiting Room Not Applicable
6
. What did you like about our clinic?
What did you like about our clinic?
7
. How would you rate your condition since attending our clinic?
How would you rate your condition since attending our clinic?
Fully Recovered
Better
Same
Worse
8
. How likely is it that you would recommend our company to a friend or colleague?
How likely is it that you would recommend our company to a friend or colleague?
Very Likely
Likely
Probably Not
Definately Not
9
. Is there anything you would like to see us improve on?
Is there anything you would like to see us improve on?
10
. Tell Us About You:
0-20
21-34
35-54
55 +
Male
Female
Age Group / Gender
*
Tell Us About You: Age Group / Gender 0-20
Age Group / Gender 21-34
Age Group / Gender 35-54
Age Group / Gender 55 +
Age Group / Gender Male
Age Group / Gender Female
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