Baraga Rehab Services Survey Question Title * 1. The administrative (front desk) staff was professional, courteous, and friendly. Yes No Unsure Question Title * 2. The therapist was on time for my appointments Strongly agree Agree Neither agree nor disagree Disagree Strongly disagree Question Title * 3. The clinic was clean, organized, and comfortable. Strongly agree Agree Neither agree nor disagree Disagree Strongly disagree Question Title * 4. The therapist helped me understand my injury or condition. Strongly agree Agree Neither agree nor disagree Disagree Strongly disagree Question Title * 5. The therapist provided me with a home exercise program to allow me to continue to progress on my own. Strongly agree Agree Neither agree nor disagree Disagree Strongly disagree Question Title * 6. To what degree did the rehab you received improve your condition? Much better Better About the same Worse Much worse Question Title * 7. I would recommend UP Rehab services to friends and family. Yes No Unsure Question Title * 8. If you require therapy in the future, how likely are you to use our services? Very likely Somewhat likely Neither likely nor unlikely Somewhat unlikely Very unlikely Question Title * 9. Which factors influenced you to choose UP Rehab? (Please check all that apply) Family/Friend Former Patient Physician recommended TV advertising Radio advertising Newspaper advertising Internet search (i.e., Google) Phonebook Facebook Question Title * 10. May we contact you regarding your feedback? Name Email Address Phone Number Question Title * 11. Do we have your permission to send you helpful information relating to optimal health and therapy? Yes No Question Title * 12. To help us serve you better, please use the space below to provide additional feedback. Done
