Enter to win $100 gift card for your office

Complete survey online at:
www.surveymonkey.com/r/BCPTreferral
OR Complete this packet and fax
"Att: Marketing Dept." to 520-325-4227

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* 1. Please enter your information below.

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* 2. Please specify your position.

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* 3. Overall, how easy do you find it to schedule appointments with Bodycentral Physical Therapy?

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* 4. How quickly are your patients scheduled with Bodycentral Physical Therapy?

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* 5. On average, how often do you refer patients to Bodycentral Physical Therapy?

  1 - 3 Patients 3 - 5 Patients 5 - 10 Patients 10+ Patients N/A
Daily
Weekly
Monthly

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* 6. What system do you use for referrals?

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* 7. Do you use Bodycentral script pads?

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* 8. What do you like about sending your patients to Bodycentral?

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* 9. What problems have you had, or what do you dislike about Bodycentral?

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* 10. What do your patients say about Bodycentral?

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* 11. How likely is it that you would recommend referring to Bodycentral to a friend or colleague?

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* 12. Do you have any comments, questions, or suggestions so we can better help you and your patients?

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* 13. On which of the following topics would you or your providers like more information? (Check all that apply)

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