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. How did you hear about our clinic *

Previous patient	Physician	Word of mouth
Advertising	Website	Facebook
Instagram	Yellow Pages	Other

Q4. What was your first impression of our clinic

Q5. How quickly did we schedule your first visit *

Q6. Friendliness of the staff who greeted you and took care of you at your first visit *

Q7. Courtesy of Support Staff in treatment and gym area *

Q8. Was your length of wait before going into the treatment area acceptable *

Q9. Appearance and cleanliness of clinic *

Q10. How well were your insurance questions answered *

Poor	Fair	Average
Good	Excellent	Not applicable

Q11. Your Therapist* *

	Strongly Disagree	Somewhat Disagree	Somewhat Agree	Agree	Strongly Agree
1. Understands my feelings and concerns
2. Was knowledgeable and clearly explained my condition/injury to me
3. Was skillful in treating me
4. My appointment was appropriate in length
5. I was satisfied with my appointment

Q12. Would you recommend our clinic to friends and relatives *

Q13. Add other comments or insights below that could help us improve your first experience with our clinic

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