2. During your initial phone call to our office, was the staff:
Friendly
Efficient
Helpful
Abrupt
Inefficient
Other

3. On your first visit to our office, was the staff:
Organized
Pleasant
Unorganized
Neutral
Rude
Knowledgeable
Other

4. How did you feel about the initial evaluation performed on you by the physical therapist?
Excellent
Good
Fair
Poor
Unneccessary

5. How did the physical therapist perform the treatment?
Excellent
Good
Fair
Poor

6. Did the staff get you into the treatment room in a timely fashion?
Yes
No

7. Did the staff set you up for your treatment comfortably?
Yes
No

8. How did you feel about the number of visits you received?
Just right
Too few
Too many

9. At the end of your treatment, did you feel like you were improved?
100%
90-100%
80-90%
70-80%
60-70%
50-60%
Less than 50%
Worse

10. Did you feel the cost of the services were:
Just right
Too little
Too much

11. What were your financial sources for payment?
Lien and Insurance
Lien Only
Worker's Comp.
Group or Individual Health
Self