This questionnaire concerns the physical therapy you received at our facility. Your answers will help us improve our services. Please answer each item by selecting the appropriate button. There is no right or wrong answer and the information provided will be treated with strict confidentiality.

  Poor Fair Good Very
Ease of administrative admission procedures
Courtesy and helpfulness of secretary
Simplicity of scheduling and time to get your first appt.
Ability of physical therapist to put you at ease and reassure you
Explanations about what will be done to you during treatment
Quality of information you received at the end of treatment regarding future
Feeling of security at all times during treatment
Extent to which treatment was adapted to your problem
Ease of access of physical therapy facilities
Comfort of room where physical therapy was provided
Calm and relaxing atmosphere in physical therapy rooms
Your physical therapy overall


Not Sure Yes
Would you recommend this facility to people close to you?
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