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