Our goal is to provide "Outstanding Patient Care".  Please help us reach and maintain this goal by filling out submitting this form.  All answers are kept confidential.  We understand that your time is valuable and we thank you for taking the time to fill out our survey.  In an effort to be GREEN our survey may be filled out "online" and submitted "online" by using the "submit" button at the bottom of the survey.  Completing our online survey is easy to do, and should take no more than 10 minutes.

 

Your privacy is very important to us!  Therefore, to protect the confidentiality of the users of our site, all of the data that you type into one of our  "online" forms is encrypted before it leaves your computer and is not decrypted until it reaches our office.

PATIENT SATISFACTION SURVEY

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PATIENT INFORMATION

 

  Date:

 

 Patient name (Optional):

 

 PERSON FILLING OUT SURVEY

Name (Optional): 

 

  Relationship to patient (Optional):

 

 Phone number (Optional): 

 

 May we contact you regarding this survey? (Optional)

Yes No

Please answer the following questions with 1 representing the

worst experience and 10 representing the best experience.
1.  How would you rate our front office responsiveness and helpfulness in scheduling and obtaining insurance information?

                          

  1       2       3       4       5       6       7       8       9      10

        Worse                               Best

2.  How would you rate the cleanliness and professional appearance of The Rehabilitation Center?

                          

  1       2       3       4       5       6       7       8       9      10

        Worse                               Best

3.  At your first visit were you properly welcomed and introduced to our staff?

                          

  1       2       3       4       5       6       7       8       9      10

       Worse                                Best

4.  Were financial/insurance questions handled in a professional manner at all times?

                          

  1       2       3       4       5       6       7       8       9      10

       Worse                               Best

5.  At your first visit did the therapist thoroughly explain your personalized treatment plan?

                          

  1       2       3       4       5       6       7       8       9      10

        Worse                               Best
 

6.  Do you feel your therapist was always available during your treatments to answer or help with any questions?

                          

  1       2       3       4       5       6       7       8       9      10

         Worse                               Best

7.  Were your treatment goals explained to you at your first visit?

                          

  1       2       3       4       5       6       7       8       9      10

        Worse                                Best
 

8.  Do you feel that our staff made every effort to help you reach your treatment goals?

                          

  1       2       3       4       5       6       7       8       9      10

        Worse                                Best
 

9.  Do you feel that any privacy matters were handled in a professional matter?

                          

  1       2       3       4       5       6       7       8       9      10

        Worse                                Best

10.  Do you feel that your treatment was beneficial?

                          

  1       2       3       4       5       6       7       8       9      10

       Worse                                 Best

11.  How likely would you be to refer a family member or friend to our practice if they needed therapy?

                          

  1       2       3       4       5       6       7       8       9      10

        Worse                                Best
 

12. Do you feel that our office hours and therapist availability are convenient and met your needs?

                          

  1       2       3       4       5       6       7       8       9      10

        Worse                               Best

 

 

 13.  Have you ever had physical therapy at another office?  Yes No

 

If yes, compared to your experience at another practice(s), is there anything that we could do to improve your treatment experience?

14.  If you answered "7" or below on questions 1 - 12 please give detailed comments:
  15.  Was there any experience at The Rehabilitation Center that you feel could be improved upon?
  16. Was there any experience at The Rehabilitation Center that you feel was excellent?
  17. Do you have any additional comments?
  Let us take this moment to say "Thank You" for taking the time to fill out this survey.  In an effort to be GREEN, please use the "Submit" button to send your survey directly to us.

 
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