About You ...

• Age
• 12-18
• 19-30
• 31-40
• 41-50
• 51-60
• 60+

• Gender
• Male
• Female

• What were you treated for?

• Who were you treated by?

• Have you been treated by us before?
• Yes
• No

About your treatment...

(1-strongly disagree, 2-disagree, 3-neutral, 4-agree,5-strongly agree )

• My privacy was protected during my physical therapy care
• 1
• 2
• 3
• 4
• 5

• My therapist was courteous and professional
• 1
• 2
• 3
• 4
• 5

• I am satisfied with the treatment provided by my physical therapist.
• 1
• 2
• 3
• 4
• 5

• It was easy to schedule all of my appointments.
• 1
• 2
• 3
• 4
• 5

• The new patient registration process met my expectations.
• 1
• 2
• 3
• 4
• 5

• I was seen promptly when I arrived for treatment.
• 1
• 2
• 3
• 4
• 5

• The location of the clinic was convient for me.
• 1
• 2
• 3
• 4
• 5

• I was satisfied with the appearance and cleaniness of the facility.
• 1
• 2
• 3
• 4
• 5

• My physical therapist clearly understood my problem or condition.
• 1
• 2
• 3
• 4
• 5

• The instructions my physical therapist gave me were helpful and was to follow.
• 1
• 2
• 3
• 4
• 5

• I received no problems with billing or statements I received.
• 1
• 2
• 3
• 4
• 5

• I am satisfied with the overall quality of my physical therapy care.
• 1
• 2
• 3
• 4
• 5

• I would recommend Doctors of Physical Therapy to family or friends.
• 1
• 2
• 3
• 4
• 5

• I would return to Doctors of Physical Therapy for care in the future.
• 1
• 2
• 3
• 4
• 5

• Comments/Suggestions?

Feel free to contact us directly with other comments or suggestions!

lvito@doctorsofphysicaltherapy.com (630)434-0271 x221