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* 1. Client

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* 2. Who was your physical therapist?

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* 3. How likely is it that you would recommend Lake Washington Physical Therapy to a friend or colleague?

NOT AT ALL LIKELY
EXTREMELY LIKELY

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* 4. Overall, how satisfied or dissatisfied are you with your therapist?

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* 5. Overall, how satisfied or dissatisfied are you with our front office and aides?

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* 6. Did you receive a handout and email/text of your home exercise program?

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* 7. Were you able to locate our clinic and find available parking?

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* 8. Were your insurance benefits (copay, co-insurance, & deductible) clearly explained to you before or during your first appointment?

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* 9. Was your diagnosis and treatment plan clearly explained to you by your physical therapist?

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* 10. What is your satisfaction with scheduling appointments and/or being placed on the cancellation list?

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* 11. What was your impression of the safety and cleanliness of the clinic?

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* 12. How can we further improve our services?

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* 13. What was the most beneficial treatment of your care plan? (check all that apply)

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