ept Rehabilitation Patient Satisfaction Questionnaire
We want to know about you.
1. Your age:
2. Your sex: Male Female
3. Have you ever been to a physical therapy office before?
yes no
4. If #3 is "yes," please check the location of the problem
for which you have received physical therapy.
neck
shoulder
lower back
elbow
hip
foot
hand
knee
Other:
5. At which ept Rehabilitation location did you receive treatment?
Eureka
Fortuna
Arcata
McKinleyville
We want to know about your treatment.
(1 – strongly disagree, 2 – disagree,
3 – no opinion, 4 – agree, 5 – strongly agree)
6. The administrative staff was helpful.
1
2
3
4
5
7. It was easy to schedule my appointments
1
2
3
4
5
8. My physical therapist was courteous.
1
2
3
4
5
9. My privacy was protected during my care.
1
2
3
4
5
10. I was satisfied by the treatment provided by my
physical therapist.
1
2
3
4
5
11. My treatment was explained in terms I could understand.
1
2
3
4
5
12. Therapy was provided in a timely manner following my
contact with the office.
1
2
3
4
5
13. I was seen promptly when I arrived for treatment.
1
2
3
4
5
14. The location of the facility was convenient for me.
1
2
3
4
5
15. I was satisfied with the appearance of the facility.
1
2
3
4
5
16. I was satisfied with the overall quality of my
physical therapy care.
1
2
3
4
5
17. I would recommend ept Rehabilitation to family and friends.
1
2
3
4
5
18. I would return to this facility if I required care in the future.
1
2
3
4
5
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