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 less 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.

REFERRING PRACTITIONER SURVEY

Referring Practitioner Surveyl.php

RESPONDENT INFORMATION

 

  Date:

 

 Respondent name (Optional):

 

 Phone number (Optional): 
  Patient's name (Optional):

 

 May we contact you regarding this survey?

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 referral information?

                             

 N/A    1       2       3       4       5       6       7       8       9      10

        Worse                                    Best

2.  How would you rate the Physical Therapist's quality of communication?

                             

N/A     1       2       3       4       5       6       7       8       9      10

        Worse                                    Best

3.  How would you rate your patients outcomes?

                          

  1       2       3       4       5       6       7       8       9      10

       Worse                                Best

4.  Are your expectations for patient care met consistently?

                          

  1       2       3       4       5       6       7       8       9      10

       Worse                               Best

5.  Are your patients generally pleased with the services of The Rehabilitation Center?

                          

  1       2       3       4       5       6       7       8       9      10

       Worse                               Best

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

                          

  1       2       3       4       5       6       7       8       9      10

       Worse                                Best

 

 

 7.  Have you ever referred a patient for physical therapy at another office?

Yes No

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

8.  If you answered "7" or below on questions 1 - 6 please give detailed comments:
  9.  Are there any experiences with The Rehabilitation Center that you feel could be improved upon?
  10. Was there any experience with 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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