877.776.9843

Dear Patient,

Thank you for choosing ProEx Physical Therapy. Please help us in our continual effort to exceed your expectations from a clinical and service perspective by completing this brief survey. Please fill in the answer that most closely expresses your opinion.

 

We Promised to Value Your Time; Please rate the following:

Excellent
Very Good
Fair
Poor
The waiting time in the office
The amount of time the physical therapist spent with you
The hours of operation
The appointment availability
Overall, how well did we value your time?

We Promised to communicate Clearly; Please rate the following:

Excellent
Very Good
Fair
Poor
The explanation of your plan of care by your Physical Therapist
Our discussions about important health factors at home or work that contributed to your recovery
Explanation of your insurance benefits by the front desk staff
Instructions on how to manage your symptoms at home
Instructions on how to prevent injury and stay healthy
Overall, how well did we communicate clearly?

We Promised to Get to Know You; Please rate the following:

Excellent
Very Good
Fair
Poor
Our ability to understand your personal goals and expectations
Our interst in you as a person, not just an injury
Overall, how well did we get to know you?

We Promised to Provide a Comfortable Environment; Please rate the following:

Excellent
Very Good
Fair
Poor
The friendliness and professionalism of the physical therapist and the support staff
The ability and willingness of the physical therapist to listen to your concerns
The friendliness and professionalism of the front desk staff
The courtesy and responsiveness over the phone
The cleanliness of the facility
The ease of directions and signage to follow
The availability of parking
Overall, how well did we provide a comfortable environment?

Your Overall Experience

Excellent
Very Good
Fair
Poor
Your Overall Outcome?
What was your overall experience?

How likely is it that you would recommend ProEx to a friend or colleague?


Clinic Location:

Comments:

Your Therapist:

Your Name(optional):