Patient Care Survey
 

Our goal is to provide our patients with an exceptional experience when they visit Axiom Physical Therapy. In order that we can better serve our patients and meet our goal of 100% patient satisfaction, we are requesting that both our past and present patients rate our performance by completing our Patient Care Survey. It will only take a few moments to fill out and the information you enter will be kept completely confidential. Your input is very important in our effort to understand where we need improve the quality of our service and where we need to offer acknowledgement for a job well done.  We thank you in advance for your help.

Patient Care Survey

Your Age:
 
Your Sex:
Male Female
 
Was this your first experience with physical therapy ?
yes no
   
Check the location of the Axiom Physical Therapy facility where you received treatment.
736 Johnson Ferry Road
1809 Canton Road
   
Please check the location of the problem for which you received physical therapy.
Neck
Lower Back
Shoulder
Elbow
Hip
Foot
Hand
Knee
Other, please indicate:
   
(1= strongly disagree, 2= disagree, 3= no opinion, 4= agree, 5= strongly agree)
A. The receptionist at the front desk:
   
The front office staff was courteous and helpful.
  1 2 3 4 5
   
It was easy to schedule all of my appointments.
  1 2 3 4 5
   
The front office staff was easily available by phone
  1 2 3 4 5
   
B. Your Physical Therapist:
   
My physical therapist was courteous.
  1 2 3 4 5
   
I was seen promptly when I arrived for treatment.
  1 2 3 4 5
   
I was satisfied by the treatment provided by my physical therapist.
  1 2 3 4 5
   
My therapist understood my problem or condition.
  1 2 3 4 5
   
I was satisfied with the overall quality of my physical therapy care.
  1 2 3 4 5
   
The instructions my physical therapist gave me were helpful.
  1 2 3 4 5
   
My privacy was protected during my physical therapy care.
  1 2 3 4 5
   
C. Our Billing Department:
   
The Billing Dept. staff was courteous and helpful.
  1 2 3 4 5
   
The Billing Dept. staff was easily available by phone.
  1 2 3 4 5
   
The Billing Dept. spent enough time with me answering my questions
  1 2 3 4 5
   
D. General
   
The location of the facility was convenient for me.
  1 2 3 4 5
   
I was satisfied with the appearance of the facility.
  1 2 3 4 5
   
I would recommend Axiom Physical Therapy to family or friends.
  1 2 3 4 5
   
Overall, I was satisfied with my experience with physical therapy.
  1 2 3 4 5
   
Comments
   

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