Physical Therapy Patient Satisfaction Survey
Name (optional)
Date of Visit
Therapist's Name
Please rate the following:
Ease of scheduling appointments
1
2
3
4
5
Facility cleanliness
1
2
3
4
5
Professionalism of staff
1
2
3
4
5
Quality of care received
1
2
3
4
5
Explanation of procedures and exercises
1
2
3
4
5
Overall satisfaction
1
2
3
4
5
Additional Comments