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Clinic Overview
Hours of Operation
Mission & Philosophy
Comprehensive Benefits
Patient Testimonials
Specialty Equipment
Facility Tour
Map / Directions
Overview of Services
Work Related Injury Rehabilitation
Outpatient Orthopedic & Sports Rehabilitation
Sports Enhancement
Spinal/Back Care Education & Rehabilitation
Pre & Post Operative Rehabilitation
Manual Therapy
Balance & Gait Training
Posture & Body Mechanics Education
Hydrotherapy
TMJ Disorders
Non-Surgical Back Treatment
Physician Survey
Physician Information
Type of Physician
Cardiologist
Chiropractor
Dentist
General Practice
General Surgeon
Internal Medicine
Neurologist
Orthodontist
Orthopedics
Plastic Surgeon
Podiatrist
Other
If other selected, please specify:
Clinical Locations
Please rate Comprehensive Therapy on the following
5 = Excellent 1 = Poor
Patient Care:
5
4
3
2
1
Timeliness:
5
4
3
2
1
Staff Courtesy:
5
4
3
2
1
Care from Therapists:
5
4
3
2
1
Convenience of location:
5
4
3
2
1
Rate patient satisfaction with Comp. Therapy:
5
4
3
2
1
Rate Comp. Therapy vs. other therapy clinics:
5
4
3
2
1
Efficiency in completing reports:
5
4
3
2
1
Ease of reaching therapists or staff members:
5
4
3
2
1
Overall Experience:
5
4
3
2
1
General Health Care Questions:
5 = High Priority 1 = No Concern
Importance of Therapy Clinic being in patient's Health Care Plan:
5
4
3
2
1
Importance for getting a patient in the same day:
5
4
3
2
1
Importance of flexible hours for scheduling patients:
5
4
3
2
1
Access to Patient information via the Internet:
5
4
3
2
1
What information would you like access to from the Internet?
Would you be interested in any of the following programs for your patients:
(Check all that apply)
Weight Loss
Work Hardening
Stop Smoking
Wellness
Healthy Eating
Stress Management
Relationship Classes
Sport Performance
Newsletter / E-Letter
Other
If other is selected, please specify:
General Comments:
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