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Survey - Corvallis Sport and Spine Physical Therapy
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What percent improvement did you experience with treatment?
Select a Value
76-100%
51-75%
25-50%
No Better
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How soon were you able to make your first appointment?
Select a Value
Same Day
Within 2 days
Within 1 week
Within 2 weeks
Excellent
Very
Good
Good
Fair
Poor
Not
Applicable
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Courtesy you experienced with our front office staff
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Ease of Scheduling
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Courtesy you experienced with our clinical staff
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Explanation of your problem and how your therapist planned to help you
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Respect for your confidentiality/privacy
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Cleanliness
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Overall quality of care and service
What did we do well with your care?
What could we have done better?
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Would you use us again?
Yes
No
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Would you recommend us to a friend?
Yes
No
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Does receiving our newsletter make you more likely or less likely to choose our services in the future?
Select a Value
More likely
Less likely
I don't receive the newsletter
Front Office Staff
Excellent
Very
Good
Good
Fair
Poor
Not
Applicable
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Knowledge of answering questions
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Respect for your privacy
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Made you feel welcome and knew your name
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Answered all your questions
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Responded to concerns in a timely manner
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Friendly and professional
Please provide constructive criticism or ways in which our Front Office Staff "wow'd" you
Billing Staff
Excellent
Very
Good
Good
Fair
Poor
Not
Applicable
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Answered your questions sufficiently
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Produced accurate billing statements
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Responded to concerns in a timely manner
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Friendly and professional in all interactions
Please provide constructive criticism or ways in which our Billing Staff "wow'd" you
Physical Therapists
Please indicate who provided care
Please indicate who else provided care
Excellent
Very
Good
Good
Fair
Poor
Not
Applicable
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Respected your privacy
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Educated you regarding your diagnosis, treatment plan and procedures
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Answered your questions
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Spent adequate time to know you and not rush you and provided undivided attention on you
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Provided care that significantly improved your symptoms
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Provided home instructions to further my treatment progress
Please provide constructive criticism or ways in which our Physical Therapists "wow'd" you
Name (optional):
Phone (optional):
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Would you like the clinic to contact you?
Yes
No
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