Dear Friend,
Wyoming Specialized Physical Therapy strives to deliver the best possible physical therapy services. We are interested in learning from our patients, how we might improve or enhance our services. Please take a few moments to complete and return this questionnaire.

Please select a location:

Bridger Valley

Evanston

Your Gender:

Female

Male

How did you learn about this facility? (Check all that apply)

	Physician
	Friend
	Insurance Company
	Former Patient
	Telephone Book
	Newspaper
	Internet
	Radio
Other:

Please rate your degree of satisfaction with each of the following statements.	Very Satisfied	Satisfied	Dissatisfied
1. Your physical therapist’s understanding of your condition.
2. Explanation of your physical therapy treatment program.
3. Treatment provided by your physical therapist.
4. Your physical therapy instructions at time of discharge.
5. Respect for your privacy during physical therapy care.
6. Were your goals for coming to physical therapy met?
7. Overall, satisfaction with my experience in physical therapy.
8. Ability to make convenient appointments.
9. Contacting the physical therapy office by telephone.
10. Physical therapy office hours.
11. Length of time waiting before receiving treatment.
12. Was the office clean and in good repair?
13. Was your billing statement processed in a correct and timely manner?

I would recommend this facility to family or friends.

Yes

No

Comments:

Thank you, for taking the time to complete this questionnaire.