Attain Your Greatness
(203) 966-3076
Home
About
Our Mission
Our Office
Our Staff
Insurance and Billing
Your First Visit
Educational Videos
In The News
Links
Survey
Services
Orthopedic
Pelvic
Neurological
Pediatrics
Injury Prevention
Therapeutic Massage
Additional
Successes
Questions
Lecture Series
Store
Forms
Blog
Pay Your Bill
Contact
Home
» FIRST IMPRESSIONS SURVEY
Question marked with * are mandatory.
FIRST IMPRESSIONS SURVEY
Q1.
Have you had Physical Therapy Treatment Before?
Yes, at our clinic
Yes, at another clinic
No
Q2.
What was your first impression of our clinic?
Q3.
How quickly we scheduled your first visit: *
Poor
Fair
Good
Very Good
Excellent
Q4.
How did you hear about our clinic? *
Word of mouth
Advertising
Yellow Pages
Online
Other
If Other, how did you hear about us?
Q5.
Friendliness of the staff who greeted you and took care of you at your first visit : *
Poor
Fair
Good
Very Good
Excellent
Q6.
How well your therapist clearly explained your condition and future treatment plan : *
Poor
Fair
Good
Very Good
Excellent
Q7.
How well your insurance questions were answered : *
Poor
Fair
Good
Very Good
Excellent
Not Applicable
Q8.
How well your therapist explained your home exercise program : *
Poor
Fair
Good
Very Good
Excellent
Q9.
Add other comments or insights below that could help us improve your first experience with our clinic.
Please enter the following text in the box
Enable Javascript for audio controls
Injuries & Conditions
Sports Activities
Lifestyle Activities
Work Activities
Injury Care
Women's Health Issues
Pain Care
Movement Disorders
Newsletter Sign-up
Sign Up for Newsletter
Close
x
x
Sending...
Thank you for signing up.
You have been added to our newsletter list.
Email
First name
Yes, I would like to receive newsletters from Philip Physical Therapy.
Privacy Policy
Terms of use
Copyright (2021) Philip Physical Therapy. All rights reserved.
Facebook
COVID-19 Updates
See More
X