Patient Satisfaction Survey

Because we strive to deliver the best possible physical therapy services, we are interested in learning from our clients how we might improve or enhance our services. 

Please take a few minutes to complete and submit this survey.

Thank you for your feedback. 

It helps us to provide the best care possible.

    Print the last name of your therapist if you remember it.

    Why did you choose THIS office/therapist? (Required)
    Telephone DirectoryFriend/FamilyInsurance BookPhysician ReferralAttorneyOther

    If other, please specify.

    Who is your primary care physician? (Required)

    Was there a specialist physician that referred you? (If yes, who?)

    My therapist was courteous
    Strongly AgreeAgreeNeutralDisagreeStrongly Disagree

    My therapist understood my problem or condition
    Strongly AgreeAgreeNeutralDisagreeStrongly Disagree

    The explanations my therapist gave me were helpful
    Strongly AgreeAgreeNeutralDisagreeStrongly Disagree

    The front desk was courteous
    Strongly AgreeAgreeNeutralDisagreeStrongly Disagree

    I was satisfied with the treatment provided by my therapist
    Strongly AgreeAgreeNeutralDisagreeStrongly Disagree

    I was satisfied with the treatment provided by the assistants
    Strongly AgreeAgreeNeutralDisagreeStrongly Disagree

    The facility scheduled appointments and convenient times
    Strongly AgreeAgreeNeutralDisagreeStrongly Disagree

    My first visit was scheduled quickly
    Strongly AgreeAgreeNeutralDisagreeStrongly Disagree

    It was easy to schedule follow-up appointments

    I was seen promptly when I arrive for treatment
    Strongly AgreeAgreeNeutralDisagreeStrongly Disagree

    The location of the facility was convenient for me
    Strongly AgreeAgreeNeutralDisagreeStrongly Disagree

    Parking was available for me
    Strongly AgreeAgreeNeutralDisagreeStrongly Disagree

    My bills were accurate
    Strongly AgreeAgreeNeutralDisagreeStrongly Disagree

    The cost of treatments I received were reasonable
    Strongly AgreeAgreeNeutralDisagreeStrongly Disagree

    I would recommend this facility for care in the future
    Strongly AgreeAgreeNeutralDisagreeStrongly Disagree

    I would return to this facility for care in the future
    Strongly AgreeAgreeNeutralDisagreeStrongly Disagree

    My privacy was respected during my care
    Strongly AgreeAgreeNeutralDisagreeStrongly Disagree

    Overall, I was satisfied with my experience here
    Strongly AgreeAgreeNeutralDisagreeStrongly Disagree

    Your age

    Your gender
    MaleFemale

    Your ethnicity
    Caucasian/WhiteHispanic/LatinoBlack/African AmericanAsian/Pacific IslanderOther

    Choose the BEST description of your problem (Required)
    Post OperativeChronicSevereMinorOther

    What did you like BEST about your experience? (Required)

    What did you like LEAST about your experience? (Required)

    What would you say to someone considering this therapist or our facility? (Required)

    Did any of the FRONT OFFICE staff help make our experience at Community Rehab PT memorable? (Required)
    YesNo

    If yes, who? Please explain what they did.

    How could we improve our front office? (Required)

    Did any of the CLINICAL staff help make our experience at Community Rehab PT memorable? (Required)
    YesNo

    If yes, who? Please explain what they did.

    How could we improve our treatments? (Required)

    Have you recommended us to any family member or friend? (Required)
    YesNo

    If yes, may we ask whom? Could you share what you said about us? If no, could you explain why?

    May we use your statements in our literature?(Required)
    YesNo

    May we use your name in our literature? (Required)
    YesNo

    (If you answered yes to both questions above, please complete the rest of this form.)

    Name

    Email Address

    Phone Number

    Street Address

    Street Address 2

    City

    State

    Zip Code