Patient Satisfaction Survey

We appreciate your choosing Palmer Physical Therapy for Women for your physical therapy needs. Our goal is to provide you with the best service and care. Your input about your experience with us will help us evaluate our operations and services to ensure we are truly responsive to your needs. Please take a moment to let us know what you think.

Satisfaction: *

	1 Very Satisfied	2 Somewhat Satisfied	3 Somewhat Disatisfied	4 Very Disatisfied
Comfort of the facility
Waiting time in the reception area
Treatment by the receptionists
Handling of your phone calls (i.e., courteous, not on hold long time, etc.)
Timely response for returned calls
Privacy and confidentiality are respected
Explanation of billing procedures and financial responsibilities
Professional conduct of my physical therapist
Information about my condition was shared in terms I could understand
Knowledge and skill of therapist about my type of problem
Caring and compassionate attitude of staff
Explanation of plan of care and what I should expect
Amount of time and personal attention for my session
Information I received about how I can help myself at home was valuable

Please answer the following with a yes or no.: *

	Yes	No
I am better off as a result of my care (i.e., less pain, better function, more informed about my condition, etc.).
I would recommend this clinic to a friend or family member.
I would you come back to this clinic for any other physical therapy needs.

Name of your Physical Therapist: *

Is there anything we can do to improve our services to you or your family?:

Name (optional):

e-mail:

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Palmer Physical Therapy

for Women

2020 N WEBB RD #104

WICHITA, KS 67206

phone: 316-630-9944

fax: 316-630-9945

Patient Satisfaction Survey