Discharge Survey Discharge Survey How would you rate your overall therapy experience?*Required12345678910On a scale of 1-10, 1 being unsatisfactory and 10 being excellent.How would you rate the cleanliness of the facility?*Required12345678910On a scale of 1-10, 1 being unsatisfactory and 10 being excellent.How would you rate the sufficiency of the office equipment?*Required12345678910On a scale of 1-10, 1 being unsatisfactory and 10 being excellent.How would you rate the accessibility of the facility?*Required12345678910On a scale of 1-10, 1 being unsatisfactory and 10 being excellent.Would you say that the facility was overcrowded?*RequiredNoYesHow knowledgable was your therapist?*Required12345678910On a scale of 1-10, 1 being unsatisfactory and 10 being excellent.How would you rate your therapist's ability to answer questions?*Required12345678910On a scale of 1-10, 1 being unsatisfactory and 10 being excellent.How attentive was your therapist?*Required12345678910On a scale of 1-10, 1 being unsatisfactory and 10 being excellent.Did your therapist meet your expectations?*RequiredYesNoHow would you rate the skill of your therapist?*Required12345678910On a scale of 1-10, 1 being unsatisfactory and 10 being excellent.How would you rate the support staff's ability to schedule appointments?*Required12345678910On a scale of 1-10, 1 being unsatisfactory and 10 being excellent.How would you rate the support staff's ability to answer questions?*Required12345678910On a scale of 1-10, 1 being unsatisfactory and 10 being excellent.How would you rate the support staff's ability to assist you in any other fashion?*Required12345678910On a scale of 1-10, 1 being unsatisfactory and 10 being excellent.How would you rate the ability of the insurance/billing staff to answer your insurance questions?*Required12345678910On a scale of 1-10, 1 being unsatisfactory and 10 being excellent.How likely are you to refer a friend?*Required12345678910On a scale of 1-10, 1 being extremely unlikely to 10 being extremely likely.How likely to write a review on yelp/google review?*Required12345678910On a scale of 1-10, 1 being extremely unlikely to 10 being extremely likely.Suggestions for improvement?CAPTCHA Δ