Long Lake Physiotherapy Patient Satisfaction Survey Question Title 1. How many times have you attended Long Lake Physiotherapy in the past year? Initial Assessment Only 2-5 Treatments > 5 Treatments Initial Assessment Only 2-5 Treatments > 5 Treatments Question Title 2. How were your treatment(s) paid for? (Choose all that apply) Self/Private Extended Health Insurance ICBC WorkSafe BC MSP RCMP, DVA or DND Other Self/Private Extended Health Insurance ICBC WorkSafe BC MSP RCMP, DVA or DND Other If other, please specify: Question Title 3. What is your age? 18-30 31-50 51-65 >65 18-30 31-50 51-65 >65 Question Title 4. How would you rate the following at Long Lake Physiotherapy? Strongly Dissatisfied Dissatisfied Neutral Satisfied Very Satisfied Location and parking Location and parking Strongly Dissatisfied Location and parking Dissatisfied Location and parking Neutral Location and parking Satisfied Location and parking Very Satisfied Courtesy of reception Courtesy of reception Strongly Dissatisfied Courtesy of reception Dissatisfied Courtesy of reception Neutral Courtesy of reception Satisfied Courtesy of reception Very Satisfied Punctuality Punctuality Strongly Dissatisfied Punctuality Dissatisfied Punctuality Neutral Punctuality Satisfied Punctuality Very Satisfied Cleanliness Cleanliness Strongly Dissatisfied Cleanliness Dissatisfied Cleanliness Neutral Cleanliness Satisfied Cleanliness Very Satisfied Expertise of your physiotherapist Expertise of your physiotherapist Strongly Dissatisfied Expertise of your physiotherapist Dissatisfied Expertise of your physiotherapist Neutral Expertise of your physiotherapist Satisfied Expertise of your physiotherapist Very Satisfied Explanation of your injury/pain and treatment plan Explanation of your injury/pain and treatment plan Strongly Dissatisfied Explanation of your injury/pain and treatment plan Dissatisfied Explanation of your injury/pain and treatment plan Neutral Explanation of your injury/pain and treatment plan Satisfied Explanation of your injury/pain and treatment plan Very Satisfied Equipment and educational materials Equipment and educational materials Strongly Dissatisfied Equipment and educational materials Dissatisfied Equipment and educational materials Neutral Equipment and educational materials Satisfied Equipment and educational materials Very Satisfied Fees Fees Strongly Dissatisfied Fees Dissatisfied Fees Neutral Fees Satisfied Fees Very Satisfied Availability of convenient appointment times Availability of convenient appointment times Strongly Dissatisfied Availability of convenient appointment times Dissatisfied Availability of convenient appointment times Neutral Availability of convenient appointment times Satisfied Availability of convenient appointment times Very Satisfied Question Title 5. What impressed you the most with the physiotherapy services you received at Long Lake Physiotherapy? Question Title 6. Do you have any suggestions that would help us improve our physiotherapy services? Question Title 7. Based on your personal experience, would you refer a friend or family member to Long Lake Physiotherapy? Yes No Yes No Question Title 8. You are welcome to submit your survey responses confidentially by clicking "Done" now. If you would like to attach your name to your survey responses, please enter your contact information below: Name Email Address Question Title 9. We would appreciate the opportunity to use your feedback on our website and social media sites. Do you consent to the public use of your name (if provided) and responses in future marketing initiatives by Long Lake Physiotherapy? Yes No Yes No Thank you for taking the time to complete our survey. Your feedback is greatly appreciated. Done
