Integrated Therapy Patient Feedback
We would love to hear your thoughts or feedback on how we did well and how can improve your treatment!
Patient Name
Your answer
Email Address
Your answer
Referring Physician *
Your answer
Customer Satisfaction *
How satisfied were you with the Office Personnel?
How satisfied were you with the Physical Therapy Clinical Staff?
Which Therapist did your evaluation? *
Your answer
Which Therapist did your treatment? *
Your answer
How satisfied were you with the level of knowledge your therapist had regarding your physical condition and treatment?
What I would like for you to know about my therapist.
Your answer
Has your physical condition improved due to your Aquatic Physical Therapy with us? *
If "Yes", what are some things you are now able to do that you could not do prior to having Aquatic Physical Therapy?
Your answer
If you have had land based Physical Therapy, how satisfied are you with your experience with Integrated Therapy in comparison to your previous Physical Therapy?
Please tell us how we may improve our services:
Your answer
May we share your comments with your Referring Physician? *
Additional Comments:
Your answer
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