Customer Service Survey Patient NameOptional - you may remain anonymous First Last Therapist Name: First Last Score from 5: highly satisfied to 1: not satisfiedPlease feel free to leave any additional comment that may be useful to our office. We want to provide the highest level of care possible!Was it easy to schedule an appointment?54321CommentDid our supporting staff correspond with you in a prompt and friendly manner?54321CommentWas your doctor sensitive to your needs?54321CommentWas your therapy time spent efficiently?54321CommentDid we start on time?54321CommentWere the activities in-office explained thoroughly?54321CommentWere the home exercises and plan clearly explained?54321CommentWere you satisfied with the therapy?54321CommentHow would you rate your overall experience?54321CommentWould you return to our office?54321CommentWould you refer a friend?54321CommentPlease Describe Your Overall ExperienceThank you for your time!Dr. Amanda Barker Assell Dr. Sandi Farnham
