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Patient Satisfaction Survey

 


Consider your visit to Holsman Physical Therapy and Rehab. Please rate each of the following.

Which services did you receive?

Clinical Staff
1. Friendly & courteous behavior

2. Professional behavior

3. Professional appearance

4. Communication regarding your treatment
Unacceptable

5. Attention/Time given to your needs

6. Overall quality of clinical support staff

We appreciate any additional comments or suggestions:

Office Staff
1. Friendly & courteous behavior

2. Professional behavior

3. Professional appearance

4. Communication regarding your treatment

5. Attention/Time given to your needs

6. Overall quality of clinical support staff

We appreciate any additional comments or suggestions:

Clinical Facilities
1. Condition/Cleanliness of clinic

2. Furnishings & Door

3. Parking convenience

4. Location of clinic

5. Overall comfort & appeal

We appreciate any additional comments or suggestions:

Overall Impression
1. Overall quality of the clinic

2. Satisfaction with your treatment so far

3. If given the opportunity, would you recommend this clinic to others?

4. Would you recommended this clinic to others?

5. Were goals set for your treatment?

6. Were these goals clearly defined and understandable?

7. Did your caregiver encourage your involvement in goal setting?

8. Is this your first experience with rehabilitative therapy

9. Have you used this clinic before in the past?

10. In your opinion how does your experience at our facility compare to past treatment you received elsewhere?

11. What city are you from?

12. Who was your primary caregiver at Holsman Physical and Rehab?

13. Is there any statement/testimonial that you would like to say that may be printed in our future literature?

Optional
Name
Phone Number


Thank you for your responses. Your feedback allows us to provide patients high quality care.