Patient Satisfaction Survey

Thank you very much for taking a few minutes of you time to complete our survey. We strive to provide not just quality care, but to make your overall experience at our facility a positive one. We hope that we will continue our relationship should you need our services in the future.

Please print this form if you want to fax or mail it here.

Please rate the following:

5-Excellent, 4-Good, 3-Average, 2-Poor, 1- Unacceptable

1. Scheduling your initial appointment.

5 - 4 - 3 - 2 - 1 -

2. Scheduling your initial appointment.

5 - 4 - 3 - 2 - 1 -

3. Your average wait time to be taken for treatment.

5 - 4 - 3 - 2 - 1 -

4. Your therapist's knowledge of your condition.

5 - 4 - 3 - 2 - 1 -

5. Your questions answered by the therapeutic staff and front desk personnel.

5 - 4 - 3 - 2 - 1 -

6. Your overall experience with our office.

5 - 4 - 3 - 2 - 1 -

7. Your chance of returning to our facility for future care.

5 - 4 - 3 - 2 - 1 -

Thank you!