TOTAL PHYSICALTHERAPY - PATIENT SATISFACTION SURVEY
Thank you for choosing Total Physical Therapy as your physical therapy provider. We truly value you as a patient and would like to continue to provide outstanding service to your EVERY VISIT! Your honest feedback is appreciated. Please help us to exceed your expectations by filling out this brief survey. Thank you for your time.
Name of your Referring Physician:
Paperwork and procedures were explained in a clear and helpful manner.
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5
Very Satisfied
Very Dissatisfied
1 is Very Satisfied, 5 is Very Dissatisfied
Handling of billing and co-pays
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4
5
Very Satisfied
Very Dissatisfied
1 is Very Satisfied, 5 is Very Dissatisfied
Courtesy of office personnel
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2
3
4
5
Very Satisfied
Very Dissatisfied
1 is Very Satisfied, 5 is Very Dissatisfied
Courtesy of clinic staff
1
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4
5
Very Satisfied
Very Dissatisfied
1 is Very Satisfied, 5 is Very Dissatisfied
Phone etiquette of clinic staff
1
2
3
4
5
Very Satisfied
Very Dissatisfied
1 is Very Satisfied, 5 is Very Dissatisfied
Clinician introduced him/herself to me personally
Yes
No
The evaluation and treatment I received was explained in a clear and helpful manner
1
2
3
4
5
Very Satisfied
Very Dissatisfied
1 is Very Satisfied, 5 is Very Dissatisfied
The aides/techs were helpful and courteous in all aspects of my care
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2
3
4
5
Very Satisfied
Very Dissatisfied
1 is Very Satisfied, 5 is Very Dissatisfied
Helpful responses were provided for my questions and concerns
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3
4
5
Very Satisfied
Very Dissatisfied
1 is Very Satisfied, 5 is Very Dissatisfied
My initial evaluation was scheduled within 24-48 hours or within my desired time frame
Yes
No
Appointments were scheduled to my convenience
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4
5
Very Satisfied
Very Dissatisfied
1 is Very Satisfied, 5 is Very Dissatisfied
When I arrived for my appointment the service began promptly
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4
5
Very Satisfied
Very Dissatisfied
1 is Very Satisfied, 5 is Very Dissatisfied
I received enough individual attention from my therapist
1
2
3
4
5
Very Satisfied
Very Dissatisfied
1 is Very Satisfied, 5 is Very Dissatisfied
My clinician communicated with my doctor regarding my therapy process
1
2
3
4
5
Very Satisfied
Very Dissatisfied
1 is Very Satisfied, 5 is Very Dissatisfied
Please rate the improvement in your condition due to physical therapy
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4
5
Very Satisfied
Very Dissatisfied
1 is Very Satisfied, 5 is Very Dissatisfied
Cleanliness of facility
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3
4
5
Very Satisfied
Very Dissatisfied
1 is Very Satisfied, 5 is Very Dissatisfied
Atmosphere
1
2
3
4
5
Very Satisfied
Very Dissatisfied
1 is Very Satisfied, 5 is Very Dissatisfied
Equipment type of availability
1
2
3
4
5
Very Satisfied
Very Dissatisfied
1 is Very Satisfied, 5 is Very Dissatisfied
Parking
1
2
3
4
5
Very Satisfied
Very Dissatisfied
1 is Very Satisfied, 5 is Very Dissatisfied
What is your overall impression of Total Physical Therapy?
1
2
3
4
5
Very Satisfied
Very Dissatisfied
1 is Very Satisfied, 5 is Very Dissatisfied
What could we have done to make your visit better?
Would you refer someone to Total Physical Therapy?
Yes
No
Would you recommend that your physician refer patients to Total Physical Therapy?
Yes
No
Can we share your comments as testimonials or with your referring physician?
Yes
No
Optional - Name (First Name, Last Name)
Optional - Contact Email
Optional - Comments
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