Patient Survey


MY HISTORY

This was the first time I received treatment from a physical therapist.


This was my first time to be treated by a HealthActions therapist.


I received my physical therapy at the clinic in:


I was familiar with HealthActions and its facilities before my doctor sent me here.


My first contact with the clinic was:



MY EXPERIENCE

very poor poor fair good very good
My first contact with HealthActions
Getting my first appointment scheduled, including the paperwork
Helpfulness of front desk staff
Explanation of payment options and financial responsibilities
My first therapy appointment for assessment, evaluation and planning
Sensitivity and attentiveness of the physical therapist
Therapist explanation of findings and treatment plan
The privacy that was provided
The convenience of appointment time for future visits
My subsequent physical therapy visits were overall
The length of my visits
The number of my visits
The friendliness of the employees
My discharge instructions, including things to continue at home
very poor poor fair good very good


MY RESULTS

My impression of the result of my therapy was that it:


I would recommend your services to others with problems similar to mine:



OPTIONAL INFORMATION

Name:

Phone Number:

Email Address:


SUCCESS STORY
If you had success with your physical therapy treatment please take a few moments to write in your own words the benefits you received from therapy (below).

I agree to allow HealthActions to publish or otherwise make public my Success Story, in whole or in part.

CONCERNS/COMMENTS
If you have concerns or comments about treatment or any aspect of our delivery of service please write these comments here.


 

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