Patient Satisfaction Survey

Please take a moment to express yourself & help us serve you better!
Please choose the number that best fits your feelings & experiences at our office. Give us your comments at the bottom of this form. Thanks for your valuable comments!

Please score 1-5 (low rating being 1, highest rating being 5) for each of the following criteria:
The Clinic was neat & clean.
The front office staff was courteous & helpful.
I was able to schedule appointments that were convenient for me.
The billing procedure was described clearly by the staff prior to my first visit and through out.
The professional staff was knowledgeable offering the level of treatment care to be comfortable and effective.
My treatment plan was clearly explained to me.
I feel I am progressing towards the treatment goals discussed by my primary physical therapist.
I was instructed in thorough home program that I understood.
The treatment I received from Therapy was beneficial.
I would recommend this facility to family and friends.
Things I like MOST about progressive
Things I like LEAST about progressive
Patient Name (Optional)
To your referring Doctor
On Our website under Patient Testimonies

Sum of 1 + 0 =