Customer Survey

1. Was the front desk staff friendly, courteous, and helpful? Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
2. How long did you have to wait for someone to explain to you your insurance benefits? 1st Visit
2nd Visit
3rd Visit
No one explained them to me.
Other (please explain in the comments field below)
3. Did you have a complete understanding of your insurance benefits? Yes
No (please explain in the comments field below)
4. Once you completed the patient information intake forms, how long did you wait before being seen by your physical therapist? Less than 5 minutes
5-10 minutes
More than 10 minutes
5. How satisfied were you with the overall cleanliness of the facility? Completely Dissatisfied
Dissatisfied
Neutral
Satisfied
Completely Satisfied
6. How satisfied were you with the overall care provided by your physical therapist? Completely Dissatisfied
Dissatisfied
Neutral
Satisfied
Completely Satisfied
7. If you are no longer receiving treatment, do you feel your problem or complaint has been: Greatly Improved
Improved
Somewhat Improved
Not Improved
Worsened
8. Would you recommend our clinic to family and friends? Yes
No
9. Do you have any suggestions about how we could improve our service to you or any additional comments?
Name:
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