Contact
Billing Inquiries
Cancel/Confirm Appointments
Employment Opportunities
New Appointment Request
Physical Therapy Survey
Request for Portal Registration

Services
Call Center
Center For Sleep Disorders
Clinical Studies
Diabetic Counseling Services
Physical Therapy
Pain Management
Weight Loss
Vitamin Infusion

Resources
Accepted Insurance Providers
Ask Our Physicians
Patient Satisfaction Survey
Refill Requests & Test Results

MENU

Make a Payment

Return to
Home

Link

Find a
Location

Link

Make an
Appointment

Link

About

Physicians

Services

Services
Center For Sleep Disorders
Clinical Studies
Diabetic Counseling Services
Physical Therapy
Pain Management
Weight Loss
Vitamin Infusion

Resources

Resources
Accepted Insurance Providers
Ask Our Physicians
Patient Satisfaction Survey
Refill Requests & Test Results

Blog

Contact

Contact
Billing Inquiries
Cancel/Confirm Appointments
Employment Opportunities
New Appointment Request
Physical Therapy Survey
Request for Portal Registration

Physical Therapy Survey

We Value Your Opinion

At 1960 Physical Therapy we are committed to making sure your therapy and rehabilitation are a priority. We would appreciate your opinions, general comments and any suggestions that you may have about the services you received at our facility.

Step 1 of 6

16%

First Name*
Last Name*
Phone
Was this your first experience with our facility?*
- Yes
- No
Were you aware of our facility before your physician referred you here?*
- Yes
- No
Location Preference
- 1960 Location (1960/Red Oak)
- 2920 Location (Spring)
- 290 Location (Cypress)
- 1960 Location (Rayford)

Please rate the following features of a physical therapy clinic by their importance to you:
Reputation in Community*
- Very Important
- Somewhat Important
- Not Important
Cost*
- Very Important
- Somewhat Important
- Not Important
Location/Clinic Hours*
- Very Important
- Somewhat Important
- Not Important
Promptness of Service*
- Very Important
- Somewhat Important
- Not Important
Clinic Atmosphere*
- Very Important
- Somewhat Important
- Not Important
Staff Skills/Attitudes*
- Very Important
- Somewhat Important
- Not Important

How well did we meet your overall expectations? Please indicate and comment on which expectations were or were not met.
Exceeded Expectations
Met Expectations
Did Not Meet Expectations

Please rate the following:
1 = strongly agree
2 = agree
3 = neutral
4 = disagree
5 = strongly disagree
My receptionist was courteous*
- 1
- 2
- 3
- 4
- 5
Name of receptionist
The clinical support staff was helpful*
- 1
- 2
- 3
- 4
- 5
Name of staff member
The receptionist was (select all that apply)*
- Competent
- Concerned
- Efficient
- Respectful
The support staff was (select all that apply)*
- Competent
- Concerned
- Efficient
- Respectful

Please rate the following:
1 = strongly agree
2 = agree
3 = neutral
4 = disagree
5 = strongly disagree
My therapist treated me with respect*
- 1
- 2
- 3
- 4
- 5
My therapist thoroughly explained the treatments I received*
- 1
- 2
- 3
- 4
- 5
My therapist answered all my questions*
- 1
- 2
- 3
- 4
- 5
My therapist advised me on ways to avoid future problems*
- 1
- 2
- 3
- 4
- 5
My therapist gave me detailed instructions for my home program*
- 1
- 2
- 3
- 4
- 5
My therapist did not spend enough time with me*
- 1
- 2
- 3
- 4
- 5
My therapist did not listen to my concerns*
- 1
- 2
- 3
- 4
- 5
The clinical support staff was (select all that apply)*
- Competent
- Concerned
- Efficient
- Respectful

Please rate the following:
1 = strongly agree
2 = agree
3 = neutral
4 = disagree
5 = strongly disagree
I am completely satisfied with the services I received from my therapist*
- 1
- 2
- 3
- 4
- 5
I am completely satisfied with the overall services of the clinic*
- 1
- 2
- 3
- 4
- 5
I would return to this clinic for future services if necessary*
- 1
- 2
- 3
- 4
- 5
Additional Comments

Back to Blog

Recent Posts

Uterine Fibroids Explained
Why Your Children Should Be Vaccinated
The Diabetes Lifestyle: Simple Steps to Living Well
What is Causing My Spider Veins?
5 Common Myths About Dieting

Make an appointment

Click here →

Link

Call in after hours

Call here →

Link

Refill requests & test results

Click here →

Link

Are you covered?

Check here →

Link

Join our team

Start here →

Link

Facebook Link Twitter Link

About

Physicians

Services

Resources

Blog

Dedicating Excellence in Protecting Your Healthcare Needs

© 1960 Family Practice

Return To Top