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North Big Horn Hospital District

Patient Satisfaction Physical & Occupational Therapy Survey

Your feedback is important.  Please take a few minutes to let us know how we can better service you and your family.
Questions marked with an asterisk (*) are mandatory.

The information you provide is protected and secure.
* How would you rate the friendliness/courtesy of registration staff (front desk of Hospital)?
* Did the person performing your therapy introduce themselves?
* Did they explain the therapy or treatment to be performed and answer your questions?
* How would you rate the friendliness/courtesy of the PT/OT staff?
  Is there a particular staff member who made an impression on you, good or bad, that you would like to tell us about?
  Please note any additional comments you would like to share with us about your visit.
* Using any number from 1 to 10, where 1 is the worst outpatient service possible and 10 is the best outpatient service possible, what number would you use to rate this outpatient service? 1     2     3     4     5     6     7     8     9     10    
* Would you recommend our outpatient services to others?
  Name and phone number (optional):