Patient Satisfaction Survey
Source Physical Therapy & Wellness strives to surpass your healthcare expectations, with exceptional PT outcomes and customer service. Please provide your (confidential) feedback, so we may continue to improve our services. Thank You
Source Physical Therapy & Wellness
Please Select Your Primary Physical Therapist
Please select the (1) Doctor you saw most, on your recent case
How Did You Hear About Our Physical Therapy Facility ?
If You Found Us on the Internet, What Site Was Most Helpful ?
OUR RECEPTIONIST TEAM
Strongly Agree
Somewhat Agree
Neither Agree Nor Disagree
Somewhat Disagree
Strongly Disagree
Was Professional & Courteous
Phone "Hold Time" Was Reasonable
Scheduled You Promptly
Parking/Location was Clearly Explained
YOUR DOCTOR OF PHYSICAL THERAPY
Strongly Agree
Somewhat Agree
Neither Agree Nor Disagree
Somewhat Disagree
Strongly Disagree
Was Professional & Courteous
Explained the Treatment & Plan of Care
Provided High Level Manual (Hands-On) Therapy
Followed Up After Completion (discharge) from PT
OUR PHYSICAL THERAPY TECHNICIANS
Strongly Agree
Somewhat Agree
Neither Agree Nor Disagree
Somewhat Disagree
Strongly Disagree
Were Professional & Courteous
Provided Clear Instruction of Exercise Performance
Demonstrated High Level Knowledge of Your Case
Printed or Emailed You a Home Exercise Program
How Likely Are You To Recommend Source PT & Wellness to a Family Member, Friend or Colleague ?
Would NOT Refer
Would ABSOLUTELY Refer
Are There Other Wellness Services You Would Like Us to Offer ? (i.e. weight loss programs, health seminars)
Your answer
Please Provide Any Additional Feedback That Would Be Helpful for Us To Improve Our Practice (optional)
Your answer
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