Majerus & Co. Patient Satisfaction Survey
i m a g i n e . l i f e . s q u a r e d
How did you hear about us?
*
Please Select
Physician Referral
Family Member or Friend
Website or Internet Search
Other
If 'Other' chosen, then how?
SERVICE
Phone calls were answered promptly
*
Please Select
Always
Most of the time
Some of the time
Hardly ever
Never
Phone calls were returned within a reasonable time frame
*
Please Select
Always
Most of the time
Some of the time
Hardly ever
Never
Not applicable
I was able to make appointments that easily coordinated with my schedule
*
Please Select
Always
Most of the time
Some of the time
Hardly ever
Never
In general, my treating therapist was on time for my appointments
*
Please Select
Always
Most of the time
Some of the time
Hardly ever
Never
FACILITY
In general, facility was clean and pleasant
*
Please Select
Always
Most of the time
Some of the time
Hardly ever
Never
Treatment rooms were clean and comfortable
*
Please Select
Always
Most of the time
Some of the time
Hardly ever
Never
Adequate space was available for my treatment
*
Please Select
Always
Most of the time
Some of the time
Hardly ever
Never
STAFF
My treating therapist acted professional and courteous
*
Please Select
Always
Most of the time
Some of the time
Hardly ever
Never
Staff members other that therapist were courteous and helpful
*
Please Select
Always
Most of the time
Some of the time
Hardly ever
Never
TREATMENT
My goals were greatly considered during the course of my therapy
*
Please Select
Strongly agree
Agree
Somewhat agree
Somewhat disagree
Disagree
Strongly disagree
My treating therapist clearly explained my treatment(s)
*
Please Select
Strongly agree
Agree
Somewhat agree
Somewhat disagree
Disagree
Strongly disagree
Written instructions for home use were clear and easy to understand (i.e. exercises, stretches, etc...)
*
Please Select
Strongly agree
Agree
Somewhat agree
Somewhat disagree
Disagree
Strongly disagree
Not applicable
Training in self-management of my condition was clear and easy to understand
*
Please Select
Strongly agree
Agree
Somewhat agree
Somewhat disagree
Disagree
Strongly disagree
I felt comfortable in discussing my care with my treating therapist
*
Please Select
Strongly agree
Agree
Somewhat agree
Somewhat disagree
Disagree
Strongly disagree
AFTERCARE
In general, I was satisfied with the results of my therapy
*
Please Select
Strongly agree
Agree
Somewhat agree
Somewhat disagree
Disagree
Strongly disagree
I was satisfied with take-home supplies provided for my home management
*
Please Select
Strongly agree
Agree
Somewhat agree
Somewhat disagree
Disagree
Strongly disagree
Not applicable
I was satisfied with the facility overall
*
Please Select
Strongly agree
Agree
Somewhat agree
Somewhat disagree
Disagree
Strongly disagree
Insurance billing was done correctly and any billing disputes were dealt with promptly
*
Please Select
Strongly agree
Agree
Somewhat agree
Somewhat disagree
Disagree
Strongly disagree
Not applicable
Would you refer others to our facility?
*
Please Select
Definitely
Most likely
Unsure
Not likely
Not at all
Additional Comments/Concerns: is there anything else we can improve on? Please let us know!
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