Outpatient Physical Therapy Survey

Dear Patient,

You recently received physical therapy services at our facility. Because we strive to deliver the best possible physical therapy services, we are interested in learning from our patients how we might improve or enhance services. Please take a few moments to complete and submit this questionnaire.

Please place a check in the appropriate box to indicate your selection, or answer the descriptive questions on the appropriate line. Any additional comments you wish to make are welcome; write in the “Comments” section at the end of the questionnaire.























  • Please rate your degree of satisfaction with each of the following statements.

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