Q1. Have you had Physical Therapy Treatment Before?

Q2. What was your first impression of our clinic?

Q3. How quickly we scheduled your first visit: *

Q4. How did you hear about our clinic? *

Q5. Friendliness of the staff who greeted you and took care of you at your first visit : *

Q6. How well your therapist clearly explained your condition and future treatment plan : *

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 : *

Q9. Add other comments or insights below that could help us improve your first experience with our clinic.

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