Patient Survey Name First Last TherapistConvenience of the location of the office? Very Satisfied Somewhat Satisfied Neutral Dissatisfied Getting through to the office by phone? Very Satisfied Somewhat Satisfied Neutral Dissatisfied The courtesy and consideration provided by the office staff? Very Satisfied Somewhat Satisfied Neutral Dissatisfied The ability to schedule a convenient appointment time? Very Satisfied Somewhat Satisfied Neutral Dissatisfied Length of time in waiting room? Very Satisfied Somewhat Satisfied Neutral Dissatisfied The information you were given about your condition and treatment plan? Very Satisfied Somewhat Satisfied Neutral Dissatisfied Your primary therapist/practitioner? Very Satisfied Somewhat Satisfied Neutral Dissatisfied Your overall therapy/care you received? Very Satisfied Somewhat Satisfied Neutral Dissatisfied Your overall rating of this facility? Very Satisfied Somewhat Satisfied Neutral Dissatisfied How would you describe your condition upon discharge? Much Improved Improved Unchanged Worse Would you return to this facility for future cases? Yes No Would you refer a family member or a friend to our facility? Yes No Δ Start Today The road to recovery starts right now. Get started today