Patient Survey Name First Last Email Who was your Therapist?Please rate the survey questions below based on the following scale. N/A = Not Applicable 1 = Unsatisfactory 2 = Fair 3 = Average 4 = Good 5 = ExcellentWas our staff friendly and helpful on the phone with you?*N/A12345Have all office staff members been courteous and helpful?*N/A12345Were your benefits adequately explained to you?*N/A12345Have the office and treatment areas always been clean and comfortable?*N/A12345Did the clinic have scheduled appointments at convenient times for you?*N/A12345Was it easy to schedule your appointments?*N/A12345Were you always seen promptly when you arrived for treatment?*N/A12345Was the check-in process prompt and efficient?*N/A12345Was your therapist courteous and helpful?*N/A12345Did your physician/therapist fully explain your problem and how they would treat it?*N/A12345Did you receive a home program and were you instructed properly in activities to do at home?*N/A12345Would you recommend this facility to your friends or family?*N/A12345Will you return to our practice if future care is needed?*N/A12345How was your overall satisfaction with your experience in therapy?*N/A12345Please share your comments: This iframe contains the logic required to handle Ajax powered Gravity Forms.