Missoula Bone & Joint Physical Therapy Patient Survey 2018

It is our goal to give you the best possible medical care. To do so, it is important that we know your thoughts about the care you
are receiving. We need to know what we are doing right and in what areas we can improve.

Please go online at https://www.surveymonkey.com/r/PTPatientSurvey2018 and complete our short survey or complete and
return this survey in the enclosed self addressed stamped enveloped. Your comments will be strictly confidential unless you respond YES in question #7. We will then use your comments in marketing and your name listed in question #8. Thank you!

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* 1. Visit Date:

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* 2. Your Therapist's Name

Bob Botkin, PT, LAT

Deann Cleveland, DPT

Marla Crago, PT

Lauren Hasquet, DPT

Kailey Ryan, DPT

Kristina Pattison, DPT

Jessica Scott, DPT

Jason Miller, PT

Samantha Morton, PT

Sydney Williams, DPT

Tim Tracy, OT

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* 3. Please rate your physical therapy experience in the following categories:

	Strongly Agree	Agree	Neither Agree or Disagree	Disagree	Strongly Disagree
The appointment process was satisfactory	The appointment process was satisfactory Strongly Agree	The appointment process was satisfactory Agree	The appointment process was satisfactory Neither Agree or Disagree	The appointment process was satisfactory Disagree	The appointment process was satisfactory Strongly Disagree
I have confidence and trust in my Physical Therapist	I have confidence and trust in my Physical Therapist Strongly Agree	I have confidence and trust in my Physical Therapist Agree	I have confidence and trust in my Physical Therapist Neither Agree or Disagree	I have confidence and trust in my Physical Therapist Disagree	I have confidence and trust in my Physical Therapist Strongly Disagree
The physical therapy staff was courteous and respectful	The physical therapy staff was courteous and respectful Strongly Agree	The physical therapy staff was courteous and respectful Agree	The physical therapy staff was courteous and respectful Neither Agree or Disagree	The physical therapy staff was courteous and respectful Disagree	The physical therapy staff was courteous and respectful Strongly Disagree
The appearance and neatness of the physical therapy facility was excellent	The appearance and neatness of the physical therapy facility was excellent Strongly Agree	The appearance and neatness of the physical therapy facility was excellent Agree	The appearance and neatness of the physical therapy facility was excellent Neither Agree or Disagree	The appearance and neatness of the physical therapy facility was excellent Disagree	The appearance and neatness of the physical therapy facility was excellent Strongly Disagree
Overall my experience was excellent	Overall my experience was excellent Strongly Agree	Overall my experience was excellent Agree	Overall my experience was excellent Neither Agree or Disagree	Overall my experience was excellent Disagree	Overall my experience was excellent Strongly Disagree

Missoula Bone & Joint Physical Therapy Patient Survey 2018

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* 1. Visit Date:

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* 2. Your Therapist's Name

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* 3. Please rate your physical therapy experience in the following categories:

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* 4. Please share one thing you would have us change to improve your experience

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* 5. Please share the best thing about your visit

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* 6. Please name a staff member who was especially helpful

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* 7. May we use your patient survey as a testimonial in our marketing?

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* 8. Your Name and Phone Number (Optional)