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?54321Comment Did our supporting staff correspond with you in a prompt and friendly manner?54321Comment Was your doctor sensitive to your needs?54321Comment Was your therapy time spent efficiently?54321Comment Did we start on time?54321Comment Were the activities in-office explained thoroughly?54321Comment Were the home exercises and plan clearly explained?54321Comment Were you satisfied with the therapy?54321Comment How would you rate your overall experience?54321Comment Would you return to our office?54321Comment Would you refer a friend?54321Comment Please Describe Your Overall ExperienceThank you for your time!Dr. Amanda Barker Assell Dr. Sandi Farnham
