Email
*
Device
Mobile Number
*
Source Page
During your visits: 1. Courtesy of staff at the front desk
Poor
Fair
Good
Very Good
Excellent
During your visits: 2. Length of wait before going to the treatment area
Poor
Fair
Good
Very Good
Excellent
During your visits: 3. Comfort and pleasantness of treatment area
Poor
Fair
Good
Very Good
Excellent
Appointment setting: 1. Ease of scheduling your appointments
Poor
Fair
Good
Very Good
Excellent
Appointment setting: 2. Courtesy of person who scheduled your appointment
Poor
Fair
Good
Very Good
Excellent
Your therapist: 1. Can view things from my perspective (see things as I see them)
Strongly Disagree
Somewhat Disagree
Somewhat Agree
Agree
Strongly Agree
Your therapist: 2. Understands my emotions, feelings and concerns
Strongly Disagree
Somewhat Disagree
Somewhat Agree
Agree
Strongly Agree
Your therapist: 3. Was knowledgeable and clearly explained my condition/injury to me
Strongly Disagree
Somewhat Disagree
Somewhat Agree
Agree
Strongly Agree
Your therapist: 4. Was skilled and effective in treating me
Strongly Disagree
Somewhat Disagree
Somewhat Agree
Agree
Strongly Agree
Comments - describe good or bad experiences
Q4. How likely are you to recommend our clinic to your friends and relatives? (1 = not likely, 10 = very likely)
1
2
3
4
5
6
7
8
9
10
Q5. What is the most important improvement we can make?
Q6. Add any other comments below
Is it ok that we send you a Google review link so you can share your experience?
Yes
No
Submit
Privacy Policy
|
Terms of Service