Patient Survey

"*" indicates required fields

1. Please choose your age range:*
2. Which statement best describes your activity level?*
3. Who originally referred you to physical therapy?*
4. Which of the following were most important in deciding which physical therapy clinic to visit? (Select up to three.)*
5. Which of the following were the most important aspects of your experience with your physical therapist? (Select up to three.)*
6. Which of the following, if any, did your therapist excel at? (Select all that apply.)*
7. Which of the following, if any, were frustrations you felt during your appointment(s)? (Select all that apply.)*
8. Which of the following would inspire you to try physical therapy again? (Select up to two.)*
9. Would you use physical therapy again if you had an ache, pain, or injury?*
10. Would you recommend physical therapy to a friend or family member?*