PATIENT SURVEY

Your Name:
E-Mail:
Who was your therapist?

Please rate the survey questions below based on the following scale.

1. Was our staff friendly and helpful on the phone with you?
Not ApplicableUnsatisfactoryFairAverageGoodExcellent

2. Have all office staff members been courteous and helpful?
Not ApplicableUnsatisfactoryFairAverageGoodExcellent

3. Were your benefits adequately explained to you?
Not ApplicableUnsatisfactoryFairAverageGoodExcellent

4. Have the office and treatment areas always been clean and comfortable?
Not ApplicableUnsatisfactoryFairAverageGoodExcellent

5. Did the clinic have scheduled appointments at convenient times for you?
Not ApplicableUnsatisfactoryFairAverageGoodExcellent

6. Was it easy to schedule your appointments?
Not ApplicableUnsatisfactoryFairAverageGoodExcellent

7. Were you always seen promptly when you arrived for treatment?
Not ApplicableUnsatisfactoryFairAverageGoodExcellent

8. Was the check-in process prompt and efficient?
Not ApplicableUnsatisfactoryFairAverageGoodExcellent

9. Was your therapist courteous and helpful?
Not ApplicableUnsatisfactoryFairAverageGoodExcellent

10. Did your physician/therapist fully explain your problem and how they would treat it?
Not ApplicableUnsatisfactoryFairAverageGoodExcellent

11. Did you receive a home program and were you instructed properly in activities to do at home?
Not ApplicableUnsatisfactoryFairAverageGoodExcellent

12. Would you recommend this facility to your friends or family?
Not ApplicableUnsatisfactoryFairAverageGoodExcellent

13. Will you return to Delta/Fillmore Physical Therapy if future care is needed?
Not ApplicableUnsatisfactoryFairAverageGoodExcellent

14. How Was Your Overall Satisfaction With Your Experience In Therapy?
Not ApplicableUnsatisfactoryFairAverageGoodExcellent

Hours of Operation

Delta Location:
Monday to Friday
8:00 AM5:00 PM

Fillmore Location:
MondayWednesdayThursday, and Friday

8:00 AM5:00 PM
Tuesday            PRN
Saturday to Sunday
Closed


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