Patient Satisfaction Survey

Matt Smith and Tom Brooks Physical Therapy is focusing on ways to improve your satisfaction with our services. Please let us know how well we are doing by taking a few moments to complete this survey.

Mark the rating for each question that best indicates your feelings about your visit.

Rating Scale: 1 = Poor, 2 = Fair, 3 = Good, 4 = Very Good, 5 = Excellent

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Visit date:
Name:
Email:
Who was your therapist?
Location:

Mark the rating for each question that best indicates your feelings about your visit. Rating Scale: 1 = Poor, 2 = Fair, 3 = Good, 4 = Very Good, 5 = Excellent
1. The telephone staff was friendly: 1 2 3 4 5
2. All other staff members were courteous: 1 2 3 4 5
3. My bills were accurate: 1 2 3 4 5
4. The office was clean and comfortable: 1 2 3 4 5
5. The clinic scheduled appointments at convenient times: 1 2 3 4 5
6. My first visit was scheduled quickly: 1 2 3 4 5
7. It was easy to schedule visits after my first appointment: 1 2 3 4 5
8. I was seen promptly when I arrived for treatment: 1 2 3 4 5
9. The check-in process was prompt and efficient: 1 2 3 4 5
10. The check-out process was prompt and efficient: 1 2 3 4 5
11. The location of the facility was convenient for me: 1 2 3 4 5
12. My physical therapist was courteous: 1 2 3 4 5
13. My therapist understood my problem or condition: 1 2 3 4 5
14. I was satisfied with the treatment provided by my therapist: 1 2 3 4 5
15. I was satisfied with the services provided by the therapy assistant/technicians: 1 2 3 4 5
16. I was given a home program and instructions at time of discharge: 1 2 3 4 5
17. I was satisfied with the overall quality of my therapy care: 1 2 3 4 5
18. I would recommend this facility to family or friends: Yes No Possibly
19. I would return to this facility if I required therapy care in the future: Yes No Possibly
20. Overall, I was satisfied with my experience with therapy: 1 2 3 4 5
Additional comments:

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Would you like to make sure our electronic messages reach your inbox? Please add survey@mattsmithpt.com to your Safe Senders list.