Rehabilitation Therapy Program Evaluation Survey
Please provide your feedback to help us improve our rehabilitation therapy services. Your responses are confidential and valuable.
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Which rehabilitation therapy program did you participate in?
*
Please Select
Physical Therapy
Occupational Therapy
Speech Therapy
Other
How long have you been attending this program?
*
Please Select
Less than 1 month
1-3 months
4-6 months
More than 6 months
Please rate the following aspects of the program:
*
Rows
Excellent
Good
Fair
Poor
Quality of therapy sessions
1
2
3
4
Professionalism of staff
5
6
7
8
Cleanliness of facility
9
10
11
12
Ease of scheduling
13
14
15
16
Communication with therapists
17
18
19
20
How satisfied are you with your overall experience?
*
1
2
3
4
5
To what extent do you feel the program has helped you achieve your rehabilitation goals?
*
Not at all
1
2
3
4
5
6
7
8
9
Completely
10
1 is Not at all, 10 is Completely
Would you recommend this program to others?
*
Yes
No
Maybe
What did you like most about the rehabilitation therapy program?
What areas do you think could be improved?
Please share any additional comments or suggestions.
Submit Feedback
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