Patient Satisfaction Survey
Personal Information
First Name
Your answer
Last Name
Your answer
Phone
Please indicate the best phone line at which to reach you
Your answer
Email
Please indicate your main email address
Your answer
Treatment Information
Treating Physician
Please name the physician who treated you
Your answer
Reason for Treatment
Please briefly describe the issues that led you to seek treatment at IPT
Your answer
Number of Visits
Please indicate the number of times you have visited IPT
Satisfaction Survey
1= poor
5 = no opinion
10 = excellent
I was greeted courteously on the phone and at the front desk.
Receptionist
My questions posed were answered to my expectations.
Receptionist
I found it easy to schedule for the times and days I wanted/needed.
Receptionist
My questions posted to the receptionist were answered to expectations.
Receptionist
The reception area was kept clean and organized.
Reception Satisfaction
My therapist spent the right amount of time with me.
Treatment/Therapist
My therapist treated me respectfully.
Treatment/Therapist
My therapist listened and answered my concerns and questions.
Treatment/Therapist
I am completely satisfied with the services received from my therapist.
Treatment/Therapist
Support staff was knowledgeable and professional.
Support Staff
I was comfortable with progression of excercises during treatment.
Support Staff
My home exercise program was explained to my satisfaction.
Support Staff
Support staff was attentive, respectful and understanding.
Support Staff
Gym/Treatment rooms were kept clean and organized to my level of expectation.
Support Staff
Overall
1= poor
5 = no opinion
10 = excellent
I would recommend IPT to others
What you were most satisfied with during your time at the clinic?
Your answer
What we can do to make future visits to our clinic more pleasant?
Your answer
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