HPT Discharge Survey Question Title * 1. Were you able to schedule most of your appointments for a time that was convenient for you ? Yes No Other (please specify) Question Title * 2. How would you rate the experience with our staff ? Excellent Good Fair Poor Receptionist Receptionist Excellent Receptionist Good Receptionist Fair Receptionist Poor Clinical Staff Clinical Staff Excellent Clinical Staff Good Clinical Staff Fair Clinical Staff Poor Billing Office Billing Office Excellent Billing Office Good Billing Office Fair Billing Office Poor Other (please specify) Question Title * 3. Overall, how often do you wait more than 5 minutes to see your therapist? (Wait time includes time spent in the waiting room) Always Most of the time About half of the time Once in a while Never Question Title * 4. Was your treatment program explained to your throughout the duration of your care? Did you feel educated about your prognosis and expected results ? Yes No How can we improve Question Title * 5. From your experience in our clinic, please rate the following? Excellent Good Average Poor Availability of parking Availability of parking Excellent Availability of parking Good Availability of parking Average Availability of parking Poor Cleanliness of facility Cleanliness of facility Excellent Cleanliness of facility Good Cleanliness of facility Average Cleanliness of facility Poor Friendliness of Staff Friendliness of Staff Excellent Friendliness of Staff Good Friendliness of Staff Average Friendliness of Staff Poor Question Title * 6. Which features of our clinic influenced you to use our services? Very Important Somewhat Important Not Important Location Location Very Important Location Somewhat Important Location Not Important Cost Cost Very Important Cost Somewhat Important Cost Not Important Staff Staff Very Important Staff Somewhat Important Staff Not Important Hours of Service Hours of Service Very Important Hours of Service Somewhat Important Hours of Service Not Important Reputation Reputation Very Important Reputation Somewhat Important Reputation Not Important Physician preference Physician preference Very Important Physician preference Somewhat Important Physician preference Not Important Question Title * 7. Success of your therapy treatment/ result ? Less than expected What I expected More that what I expected Question Title * 8. Rate your overall experience with Harper Physical Therapy? Excellent Good Fair Poor Question Title * 9. Will you recommend a friend or family member to Harper Physical Therapy? Yes No Question Title * 10. In what areas can we improve ? Done
