Client Satisfaction Survey

Question Title

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

Question Title

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

Modalities (heat, ultrasound, IFC, etc.)

N/A

Physiotherapist 'hands on'

N/A

Exercise

N/A

Education

N/A

Question Title

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

Question Title

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

Question Title

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

Question Title

* 6. Any other suggestions or comments.

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

Excellent

Very Good

Average

Poor

The length of time you waited for an initial assessment

The length of time you waited for an initial assessment Excellent

The length of time you waited for an initial assessment Very Good

The length of time you waited for an initial assessment Average

The length of time you waited for an initial assessment Poor

The length of time you waited for an initial assessment

Your involvement in setting you treatment goals

Your involvement in setting you treatment goals Excellent

Your involvement in setting you treatment goals Very Good

Your involvement in setting you treatment goals Average

Your involvement in setting you treatment goals Poor

Your involvement in setting you treatment goals

Information/education you received to help you understand more about your condition

Information/education you received to help you understand more about your condition Excellent

Information/education you received to help you understand more about your condition Very Good

Information/education you received to help you understand more about your condition Average

Information/education you received to help you understand more about your condition Poor

Information/education you received to help you understand more about your condition

Ongoing monitoring by your Physiotherapist

Ongoing monitoring by your Physiotherapist Excellent

Ongoing monitoring by your Physiotherapist Very Good

Ongoing monitoring by your Physiotherapist Average

Ongoing monitoring by your Physiotherapist Poor

Ongoing monitoring by your Physiotherapist

Ongoing monitoring by the Kinesiologist (if applicable)

Ongoing monitoring by the Kinesiologist (if applicable) Excellent

Ongoing monitoring by the Kinesiologist (if applicable) Very Good

Ongoing monitoring by the Kinesiologist (if applicable) Average

Ongoing monitoring by the Kinesiologist (if applicable) Poor

Ongoing monitoring by the Kinesiologist (if applicable)

Quality of treatment you received for your problem

Quality of treatment you received for your problem Excellent

Quality of treatment you received for your problem Very Good

Quality of treatment you received for your problem Average

Quality of treatment you received for your problem Poor

Quality of treatment you received for your problem

Helpfulness of our staff

Helpfulness of our staff Excellent

Helpfulness of our staff Very Good

Helpfulness of our staff Average

Helpfulness of our staff Poor

Helpfulness of our staff

Your comfort in discussing concerns with your Physiotherapist

Your comfort in discussing concerns with your Physiotherapist Excellent

Your comfort in discussing concerns with your Physiotherapist Very Good

Your comfort in discussing concerns with your Physiotherapist Average

Your comfort in discussing concerns with your Physiotherapist Poor

Your comfort in discussing concerns with your Physiotherapist

Progress notes and reports prepared in a timely manner (if applicable)

Progress notes and reports prepared in a timely manner (if applicable) Excellent

Progress notes and reports prepared in a timely manner (if applicable) Very Good

Progress notes and reports prepared in a timely manner (if applicable) Average

Progress notes and reports prepared in a timely manner (if applicable) Poor

Progress notes and reports prepared in a timely manner (if applicable)

Staff skill and knowledge

Staff skill and knowledge Excellent

Staff skill and knowledge Very Good

Staff skill and knowledge Average

Staff skill and knowledge Poor

Staff skill and knowledge

Length of time you waited to be seen for treatment each time you came

Length of time you waited to be seen for treatment each time you came Excellent

Length of time you waited to be seen for treatment each time you came Very Good

Length of time you waited to be seen for treatment each time you came Average

Length of time you waited to be seen for treatment each time you came Poor

Length of time you waited to be seen for treatment each time you came

Cleanliness/tidiness of the clinic

Cleanliness/tidiness of the clinic Excellent

Cleanliness/tidiness of the clinic Very Good

Cleanliness/tidiness of the clinic Average

Cleanliness/tidiness of the clinic Poor

Cleanliness/tidiness of the clinic

Question Title

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

Question Title

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

Question Title

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

Question Title

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

Question Title

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

Question Title

* 6. Any other suggestions or comments.

Question Title

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