Body Dynamics Survey
Progress: 
 
1.
How did you hear about us?
Returning Client
Referred from another client
Referred from a doctor
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Other 
2.
Is this your first physical therapy, massage, acupuncture, or pilates experience?
Yes
No
Other 
3.
How would you rate the courtesy of the Front Desk staff?
Below Standard  Standard  Above Standard       
      
  • Comment:

  • 150 character(s) left.
4.
How would your rate the courtesy of therapist or trainer?
Below Standard  Standard  Above Standard       
      
  • Comment:

  • 150 character(s) left.
5.
How would you rate the concern of the therapist/trainer for your well being?
Not Concerned    Very Concerned       
      
  • Comment:

  • 150 character(s) left.
6.
Clinician introduced him/herself personally
Yes
No
7.
The evaluation/treatment I received was adequately explained (i.e., time frames, expectations, etc.)
Yes
No
N/A
  • Comment:

  • 150 character(s) left.
8.
My questions were responded to in terms I was able to understand
Yes
No
N/A
  • Comment:

  • 150 character(s) left.
9.
The clinician was courteous, respectful and knowledgeable
Yes
No
  • Comment:

  • 150 character(s) left.
10.
My first visit was scheduled within 48 hours of my call or my desired time frame
Yes
No
11.
Appointments were scheduled to my convenience
Yes
No
  • Comment:

  • 150 character(s) left.