Patient Satisfaction Survey
Thank you for choosing Spooner/Hayward PT and Wellness! We would like to ask you about your experience while in our care. Thank you for helping us continue to improve the care we provide for our patients by taking time to answer these 20 questions.
1.
Your Sex:
Male
Female
2.
What is your age?
18 to 24
25 to 34
35 to 44
45 to 54
55 to 64
65 to 74
75 or older
3.
Was this your first experience with Physical Therapy?
Yes
No
4.
Overall, how would you rate the service you received at the reception area of our office?
Excellent
Very good
Good
Fair
Poor
5.
How satisfied are you with the cleanliness and appearance of our facility?
Extremely satisfied
Very satisfied
Somewhat satisfied
Not so satisfied
Not satisfied at all
6.
Which provider/providers did you receive therapy services from?
Erik Larson, Physical Therapist
Adam Barg, Physical Therapist
Jessica Stotz, Physical Therapist
Danielle Larson, M.A. CCC-SLP (Speech Therapist)
Other (please specify)
7.
Please indicate what body part/parts received treatment?
8.
Did your appointment with your provider start early, late or on time?
10 or more minutes early
Less than 10 minutes early
On time
Less than 10 minutes late
10 or more minutes late
9.
How well did your provider listen to your needs?
Extremely well
Very well
Somewhat well
Not so well
Not at all well
10.
How well did your provider explain your treatment options?
Extremely well
Very well
Somewhat well
Not so well
Not at all well
No treatment was required
11.
Your Physical Therapist's/Provider's understanding of your problem/condition
Extremely familiar
Very familiar
Somewhat familiar
Not so familiar
Not at all familiar
12.
How well did your provider explain your follow-up care?
Extremely well
Very well
Somewhat well
Not so well
Not at all well
No follow-up care was required
13.
Overall, how satisfied were you with your physical therapy/wellness services at either our Spooner or Hayward location?
Extremely satisfied
Very satisfied
Somewhat satisfied
Not so satisfied
Not satisfied at all
Other (please specify)
14.
On a scale of 0 to 10,
How likely is it that you would recommend your provider to a friend or family member?
0 for Not at all likely, 10 for Extremely likely
Not at all likely
Extremely likely
0
1
2
3
4
5
6
7
8
9
10
15.
Is there anything we could have done to improve your treatment services?
16.
Ability to schedule subsequent physical therapy appointments
Very easy
Easy
Neither easy nor difficult
Difficult
Very difficult
17.
How did you hear about Spooner/Hayward Physical Therapy and Wellness?
Social Media (Facebook or Instagram)
Newspaper Ad
Friend/Family Member
Radio Ad
Website
Google Search
I am a previous patient
Other (please specify)
18.
I would return to this facility if I require physical therapy again
Very likely
Likely
Neither likely nor unlikely
Unlikely
Very unlikely
19.
I enjoyed the atmosphere of Spooner/Hayward Physical Therapy and Wellness (i.e. staff, music, cleanliness)
Strongly agree
Agree
Somewhat agree
Neither agree nor disagree
Somewhat disagree
Disagree
Strongly disagree
20.
Would you be willling to provide us with a patient testimonial? If so, please comment below-
