Patient Satisfaction Survey
RequiredRequired Question(s)
Required 1.
How would you rate your overall experience with OMPT Specialists?
Excellent
Good
Fair
Poor
Required 2.

Patient's Name: 

 

50 characters left.
3.
Would you allow us to use your testimonial? If so, how would you prefer your name to appear? Example: Joe Smith could be written as Joe S. or J.S.
YES
NO
  • Comment:

  • 500 characters left.
Required 4.

Which location did you visit?

Commerce Township
Rochester Hills
Royal Oak
Shelby Township
Southfield
Troy
Troy - UnaSource
5.
Have you been to other Physical Therapy clinics before coming to OMPT Specialists?
YES
NO
6.

If you answered YES to the question above: Please describe how OMPT was different than your previous experience.

 

1000 characters left.
7.
Please rate the following questions with 1 through 5. (1 being the worst and 5 the best)
 
Telephone Demeanor: Was the staff polite and courteous on the phone?
Convenience of Appointment: Did we schedule you promptly?
Was the staff courteous and professional during every aspect of your visit?
Were all your questions/concerns addressed thoroughly and to your satisfaction?
How would you rate the sensitivity and attentiveness of your therapist?
8.

Do you feel positive enough about our services to refer friends and family?

YES
NO
  • Comment:

  • 500 characters left.
9.

What did you like about our services? Please give us your personal comments or testimonial.

 

1000 characters left.
10.

Please comment on anything regarding our services that we might change to make future patient experiences even more positive. 

 

1000 characters left.