Rehab Specialists - Patient Satisfaction Survey
All responses will be kept confidential and anonymous, and your participation is completely voluntary. Your honest feedback is important to us, and we appreciate you taking the time to complete this survey.
Sign in to Google to save your progress. Learn more
What location did you attend your session? *
What date was your evaluation? *
MM
/
DD
/
YYYY
Would you recommend this clinic to a friend, colleague, or family member? *
Not Likely
Very Likely
How satisfied were you with the cleanliness and appearance of the clinic? *
Poor
Excellent
How satisfied were you with the professionalism and friendliness of the staff? *
Poor
Excellent
How satisfied were you with the quality of care you received from your therapist? *
Poor
Excellent
How well did the therapist explain your condition and treatment plan to you?
 *
Poor
Excellent
How easy was it to schedule appointments?
 *
Very difficult
Easy
Were your questions and concerns addressed to your satisfaction?
 *
Unsatisfied
Very Satisfied
How satisfied were you with the overall experience at the clinic?
 *
Unsatisfied
Very Satisfied
Is there anything the clinic could have done better to improve your experience? Include names or type of staff  (not required)
Anyone in particular that was an outstanding RSI employee and why? (not required)
This survey is anonymous. If you would like management to look at your information individually please leave your name and contact info below. (not required).

Thank you again for choosing our clinic for your physical therapy needs. We hope that you had a positive experience and look forward to the opportunity to serve you in the future. -RSI
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Rehab Specialists Inc..

Does this form look suspicious? Report

Google Forms