Movement for Life Client Survey

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1. Contact Information (Optional)
By providing your contact information you are entered in a drawing for a $50 gift card to Target, Best Buy, or Bed Bath & Beyond!
2. When did you begin care at our clinic?
3. Please list the location of your treatment.
4. Please enter your therapist's name.
5. How many visits have you had?
6. Are you currently being treated in our clinic?
7. If you are not currently being treated in our clinic, when was your last visit?
8. Did you receive reminder calls prior to scheduled appointments?
9. For appointment reminders, what is your preference for upcoming service offerings?
10. Please rate the following:
N/APOORBELOW AVERAGEAVERAGEABOVE AVERAGEOUTSTANDING
Greeting you received each time you arrived.
Initial explanation of insurance, benefits, and billing by the front office staff.
Cleanliness of the facility.
Friendliness, hospitality, and comfort with your care providers.
Knowledge, understanding, education, and instruction given by your care provider.
Satisfaction with your clinical care and outcome of that care.
Experience with our billing process.
Interaction with our billing team.
Thank you you received at the end of each visit.
11. How did you hear about us?
12. If you are no longer visiting our clinic, has there been any follow-up communication from your therapist?
13. How likely are you to recommend us to family or friends?
14. Is there anyone you think would benefit from physical therapy that we can contact?
15. Additional Comments
16. Free Movement for Life Newsletter (Optional)
Our FREE Newsletter is sent quarterly via email and provides practical, valuable information to live a happier, healthier lifestyle.