Performance Feedback Survey

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Gathering feedback on your experience at Performance Physical Therapy allows us to continue to provide the best care to you.
 
1.

Why did you chose Performance Physical Therapy (check all that apply)?
Had previously been to Performance Physical Therapy
Internet search
Telephone Book
Physician recommendation
Word of mouth/recommendation
Insurance company recommendation
Other, please provide details
  • Comment:

  • 500 characters left.
2.

Please answer the following by checking the most appropriate box.  On a scale of 0-5, please rate your experience at Performance Physical Therapy (0 is the lowest possible score and 5 the highest possible score).
 0 1 2 3 4 5 
Overall the registration process was easy
I was offered an evaluation within 24-48 hours of my phone call
My co-payments & billing information was accurate & clearly explained
All administrative staff were professional, helpful and courteous
I was offered convenient times for my physical therapy
The Physical Therapist educated me on diagnosis and treatment plan
Evaluations and ongoing assessments were thorough
I was continually educated on an ongoing home program
I was educated on health, fitness and prevention
I was provided individualized care
  • Comment:

  • 500 characters left.
3.

Please answer the following by checking the most appropriate box.  On a scale of 0-5, please rate your experience at PPT (0 is the lowest possible score and 5 the highest possible score).
 0 1 2 3 4 5 
My privacy was respected by ALL staff
The clinic was in a convenient location and was easily accessible
The clinic was clean and aesthetically pleasing
Parking was always available
  • Comment:

  • 500 characters left.
4.

How would you rate your overall level of satisfaction with us? (please provide comments if you were not satisfied)
Highly satisfied
Somewhat satisfied
Neutral
Somewhat dissatisfied
Highly dissatisfied
  • Comment:

  • 500 characters left.
5.

Which clinic did you go to for physical therapy? (optional)
129 School St, Pawtucket
330 Cottage St, Pawtucket
400 Massasoit Ave, East Providence
1525 Wampanoag Trail, Riverside
1822 Mineral Spring Ave, North Providence
45 Seekonk St, Providence
  • Comment:

  • 500 characters left.
6.

Have you ever recommended us to others?
No, never recommended
Have recommended once or twice
Have recommended several times
No have not recommended but plan on doing so
  • Comment:

  • 500 characters left.
7.

Please feel free to submit specific feedback on your overall experience at Performance Physical Therapy.
We welcome patient testimonials that we can share with others. We also welcome photos that we can use of you participating in activities that physical therapy has helped enable you to do. 
Alternatively please feel free to contact Michelle Collie, PT, DPT, MS, OCS directly at mcollie@performanceptri.com. 

 

  • 1000 characters left.
8.
What is your age?
Younger than 18
18 - 24
25 - 34
35 - 44
45 - 54
55 - 64
65 or older
Prefer not to answer
9.

Personal information will be used to contact you to resolve concerns or request authorizations to use a testimonial you may have provided.
We will not share your information with anybody! 


By entering my personal information, I consent to receive email communications from the survey author's organization based on the information collected.

First Name:
Last Name:
Email Address:
emailaddress@xyz.com


Thank you for taking the time to provide feedback!

Please check us out online at: www.performanceptri.com