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* 1. Please indicate your status at discharge (eg. change in level of pain, change in ability, etc.)

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* 2. Which of the following were parts of your treatment? Please rank how helpful they were.

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* 3. List two things about our service that you appreciated the most.

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* 4. List two things about our service that could be improved the most.

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* 5. Would you recommend Saugeen Physiotherapy to your family and friends? Why or Why Not?

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* 6. Any other suggestions or comments.

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* 7. Please check the box that most closely describes your experience at Saugeen Physiotherapy.

  Excellent Very Good Average Poor
The length of time you waited for an initial assessment
Your involvement in setting you treatment goals
Information/education you received  to help you understand more about your condition
Ongoing monitoring by your Physiotherapist
Ongoing monitoring by the Kinesiologist (if applicable)
Quality of treatment you received for your problem
Helpfulness of our staff
Your comfort in discussing concerns with your Physiotherapist
Progress notes and reports prepared in a timely manner (if applicable)
Staff skill and knowledge
Length of time you waited to be seen for treatment each time you came
Cleanliness/tidiness of the clinic

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