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Mayers Memorial Hospital District

Physical Therapy Patient Satisfaction Survey

Please tell us about your visit to the MMHD Physical Therapy Department
Your input is important to us. Thank you for taking the time to fill out this survey.
* Date
  Were you able to schedule your appointment in a timely manner? Yes
No
  Were you seen promptly when you arrived for your appointment? Yes
No
  Was the check in process prompt and efficient? Yes
No
  Were you satisfied with the treatment provided by the Physical Therapist? Yes
No
  Please describe the improvement you experience with treatment No Improvement
A little bit better
Pretty good but still needs work
I feel great
  If you saw more than one Physical Therapist how did you feel about the change?
Please rate on a scale of 1 - 5 (Dissatisfied is 1 and Satisfied is 5)
1
2
3
4
5
  Was the receptionist helpful and courteous?
Please rate on a scale of 1 - 5 (Dissatisfied is 1 and Satisfied is 5)
1
2
3
4
5
  Was scheduling your appointment easy and convenient for you?
Please rate on a scale of 1 - 5 (Dissatisfied is 1 and Satisfied is 5)
1
2
3
4
5
  Was the Physical Therapy staff professional and respectful to your privacy?
Please rate on a scale of 1 - 5 (Dissatisfied is 1 and Satisfied is 5)
1
2
3
4
5
  Was the comfort and cleanliness of the Physical Therapy Department and restroom to your satisfaction?
Please rate on a scale of 1 - 5 (Dissatisfied is 1 and Satisfied is 5)
1
2
3
4
5
  How was the overall quality of care and service?
Please rate on a scale of 1 - 5 (Dissatisfied is 1 and Satisfied is 5)
1
2
3
4
5
  What did you like most about your visit?
  What could we have done better?
  Would you return to MMHD if you required medical care in the future? Yes
No
  Would you recommend MMHD to friends or family? Yes
No
  Please use this space for any additional comments and to let us know how we can make your experience better.
  Other comments
  Can we publish your quotes? Yes
No
  Name
Optional
  Email Address
Optional