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Patient Satisfaction Survey for Physical Therapy
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.
2.
Do you feel that your physical therapist provided you with sufficient one-on-one attention?
Yes
No
3.
Did the therapist provide you with exercise to do at home?
Yes
No
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
5.
Was the front desk physical therapy staff courteous?
Yes
No
6.
Was the front desk physical therapy staff helpful?
Yes
No
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
8.
Any additional comments?
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
Current Progress,
0 of 9 answered