Patient Quality Assurance Feedback
Please take a few moments to complete this form
Overall satisfaction
Very satisfied
Satisfied
Neutral
Unsatisfied
Very unsatisfied
Doctor Knowledge
Doctor Kindness
Conveience
Professionalism
Waiting Time
Clarity of Information
Quality of Service
How long have you been seeing your therapist at Tangerine Therapy?
Less than 6 months
At least 6 months but less than 1 year
At least 1 year but less than 2 years
At least 2 years but less than 3 years
My privacy was and is respected during my physical or occupational therapy in-home or teletherapy service appointments?
Strongly Agree
Agree
Neither Agree or Disagree
Disagree
Strongly Disagree
During your therapy visits, did your therapist listen carefully to you?
Yes, Definitely
Yes, somewhat
No
My therapist understood both parent and child's concerns/condition?
Strongly Agree
Agree
Neither Agree or Disagree
Disagree
Strongly Disagree
The therapist provided person centered and family centered care? For example, I participated in the decisions about my child's goals and treatment. My values and beliefs for my care were respected?
Strongly Agree
Agree
Neither Agree nor Disagree
Disagree
Strongly Disagree
I would return to Tangerine Therapy if my child required physical/occupational therapy care in the future?
Strongly Agree
Agree
Neither Agree nor Disagree
Disagree
Strongly Disagree
How likely is it that you would recommend Tangerine Therapy to a friend?
1
2
3
4
5
We always welcome your thoughts! Please provide us with any comments or suggestions for improving our service.
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