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    Client Survey

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Client Survey

Your feedback is important to us! If you are a current or past patient, we want to know about your experience. Please take a few moments to fill out our client survey. Your responses will be kept confidential and will help us serve you and others better in the future!





Name (optional):

How Friendly is our staff?
With 1 being “Unfriendly” and 5 being “Very Friendly.”

a. Front Office/Phone:
 1 2 3 4 5
b. Therapy Staff
 1 2 3 4 5
c. Billing Department:
 1 2 3 4 5

How would you describe the atmosphere in the clinic?

With 1 being “Unpleasant” and 5 being “Very Pleasant.”
 1 2 3 4 5

How would you describe the professional conduct of our staff?

With 1 being “Unprofessional” and 5 being “Very Professional.”
 1 2 3 4 5

Were we able to accommodate your needs? ie. scheduling, interpreting, questions,
exercise assistance, proper attention, etc.

With 1 being “Never” and 5 being “All the time.”
 1 2 3 4 5

How would you describe the clinic working space, equipment & supplies? ie. space
for exercise, cleanliness, condition of equipment, etc.

With 1 being “Inadequate” and 5 being “Very Adequate.”
 1 2 3 4 5

How well was your time utilized in the clinic?

With 1 being “Wasted” and 5 being “Very Well Used.”
 1 2 3 4 5

Did you or are you benefiting from therapy?

 Yes No

How did you hear about us?

Suggestions or Comments?

Enter Phrase
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Healing Hands, Elbows, Shoulders & the Cervical Spine

7005 N. Maple Ave. #104 • Fresno, CA 93720 • (559) 325-3503