PATIENT FEEDBACK SURVEY

Your Name:

Your Email:

Which facility did you go to for treatment:

Patient Service Coordinators/Scheduling/Phone Etiquette:

Handling of paperwork and co-pays:

Communication about insurance and pre-verification:

Courtesy of our staff overall:

Your Physical Therapist/Assistant:

Therapist's sensitivity to your pain and discomfort:

Evaluation and treatment explained in a clear and helpful manner:

Efficiency of treatment sessions:

Home exercise program developed for you:

Were you seen promptly by your therapist:

Satisfaction surrounding time spent with therapist regarding treatment and answering questions:

Cleanliness of the facility:

Cleanliness of the pool area:

Billing staff answering your inquires in a helpful manner:

Has your Physical Therapy played an important role in returning you to your prior activity level:

Would you feel confident to refer a friend or family member to CKPT:

What could we do to make your experience with us better?