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204-832-6603
Physiotherapy Works!
204-942-2463
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Quarry Physio - Stonewall
204-467-9101
Quarry Physiotherapy - Gimli
204-642-5353
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204-376-2406
Quarry Physiotherapy - Gillam
204-652-2245
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» DISCHARGE SURVEY
Question marked with * are mandatory.
DISCHARGE SURVEY
Q1.
Which location did you visit? *
Creekside Physiotherapy
Physiotherapy Works!
Portage Physiotherapy
Sage Creek Physiotherapy
Quarry Physiotherapy - Stonewall
Quarry Physiotherapy - Gimli
Quarry Physiotherapy - Arborg
Quarry Physiotherapy - Gillam
Q2.
Which service did you attend? *
Physiotherapy
Massage Therapy
Chiropractor
Sports Medicine
Nursing Foot Care
Athletic Therapy
Personal Training/Kinesiology
Dietitian
Q3.
During Your Visits *
Poor
Fair
Average
Good
Excellent
1. Courtesy of staff at the front desk
2. Length of wait before going to the treatment area
3. Comfort and pleasantness of treatment area
4. Cleanliness of the clinic
Q4.
Your Therapist *
Strongly Disagree
Somewhat Disagree
Somewhat Agree
Agree
Strongly Agree
5. Frequency of scheduled visits were appropriate
6.I completed my treatment and was discharged at a time I felt was appropriate
1. Understands my feelings and concerns
2. Was knowledgeable and clearly explained my condition/injury to me
3. Was skillful in treating me
4. Appointments were appropriate in length
7. I was satisfied with my treatment outcomes
Comment (describe good or bad experiences)
Q5.
Scheduling/Insurance *
Poor
Fair
Average
Good
Excellent
1. Ease of scheduling your appointments
2. Courtesy of person who scheduled your appointment
3. All your insurance/administrative questions were answered promptly
Comments (describe good or bad experience)
Q6.
Your likelihood of recommending our clinic to your friends and relatives *
1
2
3
4
5
6
7
8
9
10
Q7.
What is the most important improvement we can make?
Q8.
Add any other comments below
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