KPT

Patient Satisfaction

Survey

For the following questions, please rank your satisfaction on a scale of 1-5.  (1=Poor, 2=Fair, 3=Good, 4=Very Good, 5=Excellent)

Name (Optional)
Name (Optional)
Enter any specific staff members if you desire. Not required.
Education *
Understanding your diagnosis, posture, diagnosis, body mechanics, safety awareness, precautions for condition, importance with compliance with PT recommendations.
Treatment *
Hands on treatment, modalities, exercises performed with the PT/PTA.
Satisfaction *
Satisfaction with your primary PT/PTA.
ADL's and Work *
Ability to complete normal activities of daily living in the home or work environment since receiving treatment.
Social Activities *
Participation in sports, exercise, or recreational activities since receiving treatment.
Discharge *
Understanding PT recommendations and ability to continue your prescribed home exercise program.
Enter any specific staff members if you desire. Not required.

Thank you for being a patient at Kassimir Physical Therapy!

Your feedback is appreciated.