Patient Satisfaction Survey Question Title * 1. At which clinic were you seen for therapy? Elk Grove Village Hoffman Estates Both Question Title * 2. Who was your therapist? Megan Boecher Alex DeVries Kris Johnsen Stephanie Macnowski Marty Moloney Shannon Murphy Betsy Semrau Abby Sorensen-Brittich Shenya Xavier Karen Dumas Other (please specify) Question Title * 3. Today's Date Date / Time Date Question Title * 4. How would you rate the professionalism of your therapist? 5 - Excellent 4 - Very Good 3 - Good 2 - Below average 1 - Poor N - Not answered Question Title * 5. How would you rate the quality of treatment you received? 5 - Excellent 4 - Very good 3 - Good 2 - Below average 1 - Poor N - Not answered Question Title * 6. How would you rate the effectiveness/results of your treatment program? 5 - Excellent 4 - Very good 3 - Good 2 - Below average 1 - Poor N - Not answered Question Title * 7. How would you rate the confidence of your therapist's skills/knowledge? 5 - Excellent 4 - Very good 3 - Good 2 - Below average 1 - Poor N - Not answered Question Title * 8. How would you rate the level of one-on-one attention your received? 5 - Excellent 4 - Very good 3 - Good 2 - Below average 1 - Poor N - Not answered Question Title * 9. How would you rate the frequency of your appointments starting on-time? 5 - Excellent 4 - Very good 3 - Good 2 - Below average 1 - Poor N - Not answered Question Title * 10. Please rate the professionalism of the Physical Therapy front office personnel. 5 - Excellent 4 - Very good 3 - Good 2 - Below average 1 - Poor N - Not answered Question Title * 11. Please rate the etiquette of the Physical Therapy front office personnel. 5 - Excellent 4 - Very good 3 - Good 2 - Below average 1 - Poor N - Not answered Next
