Patient Satisfaction Survey Question Title * 1. How would you rate the care you receive from Link Physical Therapy Excellent Very Good Good Fair Poor Question Title * 2. How easy was it to schedule you appointment Very easy Easy Neither easy nor difficult Difficult Very difficult Question Title * 3. How comfortable is our office setting? Extremely comfortable Very Comfortable Somewhat comfortable Not so comfortable Not comfortable at all Question Title * 4. How well does your provider listen to your needs? Extremely well Very well Somewhat well Not so well Not well at all Question Title * 5. Tell us about your experience at Link Physical Therapy Question Title * 6. What makes Link Physical Therapy unique? Question Title * 7. Would you recommend Link Physical Therapy? If so, to whom? Question Title * 8. I hereby authorize Link Physical Therapy to use, reproduce, and publish these testimonials and statements. I agree and understand I shall neither be compensated for the Content nor receive attribution for the Content. I also attest that I am authorized to grant Link Physical Therapy the right to use this Content. I understand that this Content may be used in publications, press releases, marketing materials, advertisements (both digital and print), websites (including social media sites), or other uses. This authorization is continuous, and only I may withdraw this authorization through specific, written rescission. I hereby release from any liability of any kind related to the use, reproduction, or publication of the Content. Name Address Address 2 City/Town State/Province ZIP/Postal Code Country Email Address Phone Number Question Title * 9. Thank you for sharing your story! Your valuable feedback can help empower others to get the help they need. If we share your testimonial/story, please indicate your preference: OK to use my full name OK to use my initials only OK to use first name and last initial only I would like to remain anonymous Other (please specify) Done