Patient Satisfaction Survey
In keeping with our ongoing commitment to providing an optimal health care environment for our patients, we would greatly appreciate your feedback. Please rate the following statements on a scale from
1-5
.
1. Excellent
2. Above Average
3. Average
4. Below Average
5. Poor
Treatment Team
Name of therapist trainer who were your primary caregivers
1. The therapist and trainer listened carefully to your concerns
1
2
3
4
5
2. The therapist and trainer encouraged you to set goals for your rehabilitation
1
2
3
4
5
3. The therapist and trainer were friendly and put you at ease during your treatment sessions
1
2
3
4
5
4. The therapist and trainer gave you detailed and clear explanations of all procedures performed during your treatment sessions
1
2
3
4
5
5. The therapist and trainer encouraged you to ask questions
1
2
3
4
5
6. The therapist and trainer seemed genuinely concerned about you as a person
1
2
3
4
5
7. The therapist and trainer spent quality time with you during your treatment sessions
1
2
3
4
5
8. All staff members behaved in a professional manner
1
2
3
4
5
9. You were given attention in both the waiting room and treatment area
1
2
3
4
5
10. You were taken back to the treatment area promptly in regards to your scheduled time
1
2
3
4
5
Office
11. When calling to schedule your appointment(s), the person you spoke with was professional, friendly and helpful
1
2
3
4
5
12. You felt the number of day(s) you had to wait for an initial appointment was acceptable
1
2
3
4
5
13. You felt you were given proper directions to find this facility
1
2
3
4
5
14. Ability to access our office via the telephone
1
2
3
4
5
15. Convenience of the office hours
1
2
3
4
5
16. Convenience of office location
1
2
3
4
5
17. Cleanness of this facility
1
2
3
4
5
***
Would you refer family or friends to STI?
Yes
No
Please provide comments regarding your experience at STI
Name
(Optional)
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