Patient Satisfaction Survey

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Your Email (required)

1. The clinic was clean and comfortable.
 Strongly Agree Agree Disagree Strongly Disagree

2. You were able to make appointments at times that worked for you.
 Strongly Agree Agree Disagree Strongly Disagree

3. You were happy with the explanation you received about your insurance coverage?
 Strongly Agree Agree Disagree Strongly Disagree

4. Your therapist was knowledgeable about your particular type of therapy, and was helpful in answering questions.
 Strongly Agree Agree Disagree Strongly Disagree

5. You are doing everything that your therapist asked you to do to help yourself get better.
 Strongly Agree Agree Disagree Strongly Disagree

6. Now that your therapy is complete how do you feel?

7. If your friends or family needed therapy, how likely are you to refer them to Empower PT? (0 is would not refer, 10 is would refer everyone)

We would love to have further feedback on your physical therapy experience. Please write your testimonial below.

May we use your feedback for future marketing materials?
 Yes No

If yes, would you prefer Full Name or First Name, Last Initial?
 Full Name First Name, Last Initial

The next question is to help reduce email spam and make sure you are human

**You can also fill out a review on Google