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Therapists
Frederick L. Hobusch, PT, DMT, MOMT, FAAOMT
Rodney A. Miyasaki, PT, MA
Rachael A. Neumann, PT, DPT
Chiara Despain, PTA
Carolina Magleby
Services
Insurances
Contact Us
FAQs
Survey
Request An Appointment
Home
About Us
Testimonials
Therapists
Frederick L. Hobusch, PT, DMT, MOMT, FAAOMT
Rodney A. Miyasaki, PT, MA
Rachael A. Neumann, PT, DPT
Chiara Despain, PTA
Carolina Magleby
Services
Insurances
Contact Us
FAQs
Survey
Request An Appointment
Dear Patient:
We strive to deliver the best possible Physical Therapy treatment, and we are interested in learning from patients how we might improve or enhance our services. If you recently received Physical Therapy services at Westwood Physical Therapy Clinic, please take a few moments to complete this questionnaire.
Please answer each question; if you choose to remain anonymous, please indicate "Anonymous" in the "Patient Name" field. Any additional comments you wish to make are welcome in the "Comments" section at the end of the questionnaire.
Thank you very much for your feedback!
*
Indicates required field
Patient Name:
*
1. How did you learn about this facility? (Check ALL that apply)
*
Physician
Family/Friend
Former patient
Insurance company directory
Internet/website
Social media post
Other
2. Was this your first experience with Physical Therapy?
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Yes
No
3. Was this your first experience with this facility?
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Yes
No
4. Please check the location of the problem for which you received Physical Therapy (check ALL that apply):
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Neck
Shoulder
Elbow
Wrist/Hand
Lower Back
Hip
Knee
Ankle/Foot
Middle Back/Thoracic Spine
Jaw
Other
6. The courtesy of your Physical Therapist:
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Very Satisfied
Satisfied
Dissatisfied
Very Dissatisfied
Does Not Apply To Me
No Opinion
5. Respect for your privacy during Physical Therapy care:
*
Very Satisfied
Satisfied
Dissatisfied
Very Dissatisfied
Does Not Apply to Me
No Opinion
7. The courtesy of all other staff members:
*
Very Satisfied
Satisfied
Dissatisfied
Very Dissatisfied
Does Not Apply To Me
No Opinion
Please rate your degree of satisfaction with each of the following items:
8. Hours of operation:
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Very Satisfied
Satisfied
Dissatisfied
Very Dissatisfied
Does Not Apply To Me
No Opinion
9. Ability to schedule your initial Physical Therapy appointment in a timely way:
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Very Satisfied
Satisfied
Dissatisfied
Very Dissatisfied
Does Not Apply To Me
No Opinion
10. Ability to easily schedule subsequent Physical Therapy appointments:
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Very Satisfied
Satisfied
Dissatisfied
Very Dissatisfied
Does Not Apply To Me
No Opinion
11. Length of time you waited in the clinic before receiving treatment:
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Very Satisfied
Satisfied
Dissatisfied
Very Dissatisfied
Does Not Apply To Me
No Opinion
12. The location of our facility:
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Very Satisfied
Satisfied
Dissatisfied
Very Dissatisfied
Does Not Apply To Me
No Opinion
13. The manner in which payment was processed.
*
Very Satisfied
Satisfied
Dissatisfied
Very Dissatisfied
Does Not Apply to Me
No Opinion
14. The parking available:
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Very Satisfied
Satisfied
Dissatisfied
Very Dissatisfied
Does Not Apply To Me
No Opinion
15. Your Physical Therapist's understanding of your problem or condition:
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Very Satisfied
Satisfied
Dissatisfied
Very Dissatisfied
Does Not Apply To Me
No Opinion
16. Explanation of your Physical Therapy treatment program:
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Very Satisfied
Satisfied
Dissatisfied
Very Dissatisfied
Does Not Apply To Me
No Opinion
17. Services provided by your Physical Therapist:
*
Very Satisfied
Satisfied
Dissatisfied
Very Dissatisfied
Does Not Apply To Me
No Opinion
18. Services provided by your Physical Therapy Assistant:
*
Very Satisfied
Satisfied
Dissatisfied
Very Dissatisfied
Does Not Apply To Me
No Opinion
19. Services provided by your Physical Therapist's aide(s):
*
Very Satisfied
Satisfied
Dissatisfied
Very Dissatisfied
Does Not Apply To Me
No Opinion
20. Your instructions for discharge from Physical Therapy:
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Very Satisfied
Satisfied
Dissatisfied
Very Dissatisfied
Does Not Apply To Me
No Opinion
21. Overall quality of your Physical Therapy care:
*
Very Satisfied
Satisfied
Dissatisfied
Very Dissatisfied
Does Not Apply To Me
No Opinion
Please rate your degree of agreement with each of the following statements:
22. I would recommend this facility to family or friends.
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Strongly Agree
Agree
Disagree
Strongly Disagree
No Opinion
23. I would return to this facility if I required Physical Therapy care in the future.
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Strongly Agree
Agree
Disagree
Strongly Disagree
No Opinion
24. The cost of the Physical Therapy treatment received was reasonable.
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Strongly Agree
Agree
Disagree
Strongly Disagree
No Opinion
25. If I had to, I would pay for these Physical Therapy services myself.
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Strongly Agree
Agree
Disagree
Strongly Disagree
No Opinion
26. Overall, I was satisfied with my experience with Physical Therapy.
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Strongly Agree
Agree
Disagree
Strongly Disagree
No Opinion
Comments:
*
Thank you for taking the time to complete this questionnaire!
If you had a GREAT experience and know someone who could benefit from Physical Therapy, tell them about us!
Please check this box if we may anonymously use your comments on our website/social media pages:
*
Option 1
Option 2
Option 3
Submit
