Therapy Services Patient Satisfaction Survey

Thinking about your visit with the clinician you saw, how would you rate the following:

  Poor Fair Good Very Good Excellent
1. How long you waited to get an appointment
2. Convenience of the location of the office
3. Getting through to the office by phone
4. Length of time waiting at the office
5. Time spent with the clinician you saw
6. Explanation of what was done for you
7. Technical skills (thoroughness, carefulness, competence) of the clinician you saw
8. The personal manner (courtesy, respect, sensitivity, friendliness) of: 
   a. The clinician you saw
   b. The aide
   c. The reception staff
9. The visit overall
10. How are questions about your bill or insurance answered?
11a. Would you recommend the clinician you saw to your family and friends? Definitely
not
Probably
not
Probably
yes
Definitely
yes
 
11b. Would you recommend Wellington Therapy Services to your family and friends? Definitely
not
Probably
not
Probably
yes
Definitely
yes
 
12. Are you (patient) male or female? Male
Female
 
13. How old were you (patient) on your last birthday?  

Clinician who provided your care:

Location where you (patient) were seen:

Please add any comments you may have. Thank you!