TDPT - PATIENT SATISFACTION SURVEY
STAFF ATTITUDE *
Very Dissatisfied
Dissatisfied
Neutral
Satisfied
Very Satisfied
Courtesy of office personnel
Courtesy of therapist
Courtesy of aide
Concern of therapist for your well being
PROFESSIONAL DEMEANOR *
Very Dissatisfied
Dissatisfied
Neutral
Satisfied
Very Satisfied
Clinician introduced him/herself to me personally
The evaluation and treatment was adequately explained
Responses were provided for my questions and concerns
The clinician was courteous, respectful, and seemed concerned about me
QUALITY OF SERVICE *
Very Dissatisfied
Dissatisfied
Neutral
Satisfied
Very Satisfied
My initial evaluation was scheduled within my desired time frame
Appointments were scheduled to my convenience
Service began promptly
FACILITIES *
Very Dissatisfied
Dissatisfied
Neutral
Satisfied
Very Satisfied
Cleanliness of facility
Atmosphere
Equipment type and availability
Parking
Convenience of location
What was your overall impression of TDPT?
Your answer
What could we have done to make your visit better?
Your answer
What did you like most about TDPT?
Your answer
What did you like least about TDPT?
Your answer
Please let us know if any individual gave you outstanding attention so we may recognize that person.
Your answer
Additional comments:
Your answer
Would you recommend someone to TDPT? Why?
Your answer
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