Post-Care Survey Thank you for allowing us to serve you! Please take a moment to provide us your feedback regarding you care. Name What facility were you seen at? Cave Creek Moon Valley North Phoenix/Tramonto Glendale/Arrowhead Why were you referred for physical therapy? (Diagnosis or ailment) * Where your insurance benefits explained to you on or before your first visit? * Yes No On average, how long did you have to wait to see your therapist after you arrived for your scheduled visit? * Under 10 minutes 10-15 minutes More than 15 minutes How satisfied were you with the care provided by your physical therapist/chiropractor? * Very Satisfied Satisfied Somewhat dissatisfied Dissatisfied If dissatisfied, what were you dissatisfied with? * After receiving care, do you feel your complaint/problem: Greatly Improved Somewhat Improved Not Improved Worsened Would you consider referring a friend or family member to our practice? Yes No Have you any specific success as a result of your treatment that you would like to share? May we share your responses? (We will not share your personal information) * Yes No Submit Δ
