Patient Satisfaction Survey

Question Title

* 1. As a part of our continuing commitment to provide the highest quality health care, we are asking patients to participate in this survey. Your cooperation in completing this questionnaire will help us maintain and improve the care you and others receive. We assure you that your responses are strictly confidential.

Thank you in advance for taking the time to share your thoughts about the care you received. We look forward to continuing to serve your health care needs!

Thinking about your visit with the person you saw, how would you rate the following?

	Excellent	Very Good	Good	Fair	Poor
How long you waited to get an appointment	How long you waited to get an appointment Excellent	How long you waited to get an appointment Very Good	How long you waited to get an appointment Good	How long you waited to get an appointment Fair	How long you waited to get an appointment Poor
Convenience of the office location	Convenience of the office location Excellent	Convenience of the office location Very Good	Convenience of the office location Good	Convenience of the office location Fair	Convenience of the office location Poor
Getting through to the office by phone	Getting through to the office by phone Excellent	Getting through to the office by phone Very Good	Getting through to the office by phone Good	Getting through to the office by phone Fair	Getting through to the office by phone Poor
Length of time waiting at the office	Length of time waiting at the office Excellent	Length of time waiting at the office Very Good	Length of time waiting at the office Good	Length of time waiting at the office Fair	Length of time waiting at the office Poor
Satisfaction with the treatment provided by the therapist	Satisfaction with the treatment provided by the therapist Excellent	Satisfaction with the treatment provided by the therapist Very Good	Satisfaction with the treatment provided by the therapist Good	Satisfaction with the treatment provided by the therapist Fair	Satisfaction with the treatment provided by the therapist Poor
Explanation of procedures and treatments	Explanation of procedures and treatments Excellent	Explanation of procedures and treatments Very Good	Explanation of procedures and treatments Good	Explanation of procedures and treatments Fair	Explanation of procedures and treatments Poor
Courtesy, respect, friendliness of the reception staff	Courtesy, respect, friendliness of the reception staff Excellent	Courtesy, respect, friendliness of the reception staff Very Good	Courtesy, respect, friendliness of the reception staff Good	Courtesy, respect, friendliness of the reception staff Fair	Courtesy, respect, friendliness of the reception staff Poor
The quality of my physical therapy care	The quality of my physical therapy care Excellent	The quality of my physical therapy care Very Good	The quality of my physical therapy care Good	The quality of my physical therapy care Fair	The quality of my physical therapy care Poor

Question Title

* 2. Please share any other comments you have below: