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1. Please indicate how long you have been in therapy.
2. How satisfied are you with the competence of your therapist?
3. Is your therapist(s) kind, courteous, and supportive?
4. How satisfied are you with the way your treatment was explained?
5. How satisfied are you with the assistance you receive from the front desk staff?
6. Are the front desk and support staff kind, courteous, and supportive?
7. Are you satisfied that therapy has been beneficial in improving your condition?
8. Would you recommend outpatient therapy at the Physical Rehab and Sports Injury Center to others?
9. What is your therapist’s name: (please enter 2-digit number, as shown before therapist’s name).
Source: Provena St. Joseph Physical Rehab & Sports Injury Center, Joliet, IL.