Patient Satisfaction Survey
Your feedback is extremely important to us so please submit the following form. Based on your suggestion, we will improve you service and will try our level best to serve you better.

How would you rate your overall experience with Prime Health Physical Therapy? 1 2 3 4 5 (Highest)
Telephone demeanor: Were the staff polite and courteous on the phone? 1 2 3 4 5 (Highest)
Convenience of appointment: Did we schedule you promptly? 1 2 3 4 5 (Highest)
Were the staff courteous and professional during every aspect of your visit? 1 2 3 4 5 (Highest)
Were all your questions/concerns addressed thoroughly and to your satisfaction? 1 2 3 4 5 (Highest)
How would you rate the sensitivity and attentiveness of the therapist? 1 2 3 4 5 (Highest)
How would you rate your overall experience with our practice? 1 2 3 4 5 (Highest)
Are you aware that our practice is accepting new patients? YES NO
Do you feel positive enough about our service to refer family and friends? 1 2 3 4 5 (Highest)
If no, would you allow us to contact you? YES NO
What did you most like about our services?
Please comment on anything regarding our service that we might change to make future patient experience even more positive.
Please give us your personal comments or testimonials.
Your Name (optional)
May we share your comments with others? YES NO
If so, how would you like your name to appear First Name Last initial (Kate B.) or First and Last initial (KB)? First Name and Last Initial Initials ONLY Anonymous