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* 1. When was the last time you received physical therapy?

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* 2. At which place did you receive your physical therapy treatment?

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* 3. What were you treated for?

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* 4. How would you rate your experience?

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* 5. How beneficial was physical therapy beneficial to your recovery?

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* 6. Was there a recurrence of the injury?  If so how long after therapy?

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* 7. What is your age?

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* 8. What is your gender?

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