Discharge Survey

How would you rate your overall therapy experience?*

On a scale of 1-10, 1 being unsatisfactory and 10 being excellent.

How would you rate the cleanliness of the facility?*

On a scale of 1-10, 1 being unsatisfactory and 10 being excellent.

How would you rate the sufficiency of the office equipment?*

On a scale of 1-10, 1 being unsatisfactory and 10 being excellent.

How would you rate the accessibility of the facility?*

On a scale of 1-10, 1 being unsatisfactory and 10 being excellent.

Would you say that the facility was overcrowded?*

How knowledgable was your therapist?*

On a scale of 1-10, 1 being unsatisfactory and 10 being excellent.

How would you rate your therapist's ability to answer questions?*

On a scale of 1-10, 1 being unsatisfactory and 10 being excellent.

How attentive was your therapist?*

On a scale of 1-10, 1 being unsatisfactory and 10 being excellent.

Did your therapist meet your expectations?*

How would you rate the skill of your therapist?*

On a scale of 1-10, 1 being unsatisfactory and 10 being excellent.

How would you rate the support staff's ability to schedule appointments?*

On a scale of 1-10, 1 being unsatisfactory and 10 being excellent.

How would you rate the support staff's ability to answer questions?*

On 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?*

On 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?*

On a scale of 1-10, 1 being unsatisfactory and 10 being excellent.

How likely are you to refer a friend?*

On a scale of 1-10, 1 being extremely unlikely to 10 being extremely likely.

How likely to write a review on yelp/google review?*

On a scale of 1-10, 1 being extremely unlikely to 10 being extremely likely.

Suggestions for improvement?

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