Patient Survey

Name

First Last

Therapist

Convenience of the location of the office?

Getting through to the office by phone?

The courtesy and consideration provided by the office staff?

The ability to schedule a convenient appointment time?

Length of time in waiting room?

The information you were given about your condition and treatment plan?

Your primary therapist/practitioner?

Your overall therapy/care you received?

Your overall rating of this facility?

How would you describe your condition upon discharge?

Would you return to this facility for future cases?

Would you refer a family member or a friend to our facility?