Patient Satisfaction Survey for Physical Therapy

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* 1. Which Health Center did you visit today?

Midtown Health Center

Queens Health Center

Brooklyn Health Center

Harlem Health Center

Neither - This was a video visit.

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* 2. Do you feel that your physical therapist provided you with sufficient one-on-one attention?

Yes

No

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* 3. Did the therapist provide you with exercise to do at home?

Yes

No

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* 4. How long did it take to get your initial physical therapy appointment (first visit) upon request?

Less than 3 Weeks

4-6 Weeks

6-8 Weeks

Greater than 8 Weeks

This was not my first visit

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* 5. Was the front desk physical therapy staff courteous?

Yes

No

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* 6. Was the front desk physical therapy staff helpful?

Yes

No

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* 7. Overall, I am satisfied with the services I received from physical therapy.

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

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* 8. Any additional comments?

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* 9. Please enter your name and phone number if you would like us to contact you in regards to your comments. (Optional)

Name

Phone Number