Patient Satisfaction Survey

Patient Satisfaction Survey

It is our mission at Fukuji & Lum Physical Therapy to deliver fun, happiness, and compassion in serving our patients. Your experience with F&L is very important to us and we truly value your feedback. Please take a few moments to fill out this brief survey to tell us how we are doing. It is completely anonymous unless you choose to enter our drawing.
Is this your first time at Fukuji & Lum?
Did your condition improve as a result of physical therapy?

YesNoSomewhat
Which staff member did you have the most contact with?
How satisfied are you with the care you received?*

Very SatisfiedSatisfiedUndecidedUnsatisfiedVery Unsatisfied
Were you given a Home Exercise Program (HEP) and was it beneficial?
Did the Medical Receptionist provide you with friendly customer service and were they able to answer your questions?

YesNo
Do you have any suggestions on how we could improve your experience?
How likely is it that you would return to our clinic for further care? Using a scale of 0 - 10 with 10 being Extremely Likely and 0 being Not at all Likely*
How likely is it that you would refer a family member or friend to our clinic? Using a scale of 0 - 10 with 10 being Extremely Likely and 0 being Not at all Likely*
Do you have any other comments?
Thank you for participating in our survey. To show our appreciation, we'd love for you to submit your name in our prize giveaway to win a FREE Massage or PT session! First and last name (Your entry is optional)
Name:
E-mail Address
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