BUPTC Feedback Survey

Patient Satisfaction Survey / Quality Improvement Suggestions
In order to continuously improve the quality of our service we are asking that you complete the following survey. Please feel free to comment on areas where you feel we can improve and things you feel we are doing well based on your experience at our Center. This survey is confidential and your identity will only be known by the management.

Your Name:
Your Physical Therapist's Name:	*If Other, please indicate:
How did you hear about BUPTC?	*If Other, please indicate:

	Excellent	Good	Average	Needs Improvement	N/A
Ease of making your first appointment
Ease of making follow up appointments
Helpfulness and courtesy of office staff
Help understanding your benefits and billing information
Supervision and direction by your Physical Therapist
Satisfaction with your Physical Therapist’s Care
Comfort with Student Physical Therapist (if applicable)
Degree to which Physical Therapy helped your condition
Overall satisfaction with your Experience at BUPTC
Appearance / Cleanliness of the Clinic

Would you refer a family member or friend to us?
Yes No

Would you use the Internet to find a PT provider?
Yes No

How important do you feel the phonebook is to choosing a PT?
Very Important
Neutral
Not Important

Comments on how we can improve our service or other feedback: