We would like to ask you about your experience regarding your last visit to our office. Thank you for helping us continue to improve the care we provide for our patients.

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* 1. Overall, how satisfied were you with the courtesy of the office staff?

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* 2. Overall, how satisfied were you with the courtesy of the clinical staff?

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* 3. Your initial evaluation was scheduled within your desired time frame.

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* 4. Did your appointment with your provider start within a reasonable time of your arrival?

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* 5. The Physical Therapist introduced him or herself to you personally.

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* 6. How well did your provider explain your evaluation and treatment?

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* 7. How satisfied are you with the cleanliness and appearance of our facility?

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* 8. How likely is it that you would recommend your provider to a friend or family member?

Not at all likely
Extremely likely

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* 9. Is there anything we could have done to improve your last visit?

T