Physical Therapy Rehabilitation Services Question Title * 1. What was your overall opinion of our department? Excellent Very Good Good Fair Poor Question Title * 2. Was this your first visit to our department? Yes No Question Title * 3. Would you recommend this department to your friends and family? Definitely yes Probably yes Probably no Definitely no Question Title * 4. The office personnel were courteous, respectful, and promptly available. Strongly Agree Agree Disagree Strongly disagree Question Title * 5. The therapist who worked with you was caring, engaged in your treatment sessions, and considered your personal therapy needs and goals. Strongly Agree Agree Disagree Strongly disagree Question Title * 6. Were you provided with written instructions or a home exercise program? Yes No Question Title * 7. Did you achieve your therapy goals? Yes No Partial Other (please specify) Question Title * 8. Was your pain level decreased upon discharge? Yes No N/A Question Title * 9. Was your therapy covered under Workers Compensation? Yes; Returned to work full duty. Yes; Returned to work restricted duty. Yes; Unable to return to work N/A Please take an Everyone Shines Here comment card to acknowledge a staff member who deserves recognition. Question Title * 10. Contact Information (Optional) Name Email Address Phone Number If you have additional information or concerns please feel free to contact the Director of Rehabilitation at 816-629-2771. Done