Very
Satisfied

Somewhat
Satisfied

Neutral

Dissatisfied

1) Convenience of the location of the office.

2) Comfort and appearance of treatment area.

3) Overall cleanliness of facility.

4) Getting through to the office by phone.

5) The courtesy and consideration provided by office staff.

6) Office staff had a professional appearance.

7) Explained our paperwork, your insurance benfits, and answered any questions in a helpful manner.

8) Your overall rating of this facility.

9) The ability to schedule a convenient appointment time.

10) Length of time in waiting room.

11) Information you were given about your condition and treatment plan.

12) Your primary therapist.

13) The courtesy of your therapist.

14) Therapist had a professional appearance.

15) Therapist explained your therapy and answered your questions.

Much
Improved

Improved

Unchanged

Worse

16) How would you describe your condition upon discharge?

Yes

Probably

Probably Not

No

17) Would you return to this facility for future care?

18) Would you recommend our services to another person?

If no, why not?

19) In what ways could we improve or better serve you?