Patient Survey

Please take a moment to fill out our survey.

How did you hear about Paso Robles Physical Therapy? *

Internet Search Advertisement Referred by Physician Friend Word of Mouth Other

If Other please specify: *

Which clinic did you attend? *

Downtown Paso Robles Lake Nacimiento facility Both

How would you rate your overall experience at Paso Robles Physical Therapy? *

Very Unsatisfied Unsatisfied Neutral Satisfied Very Satisfied

Please rate the following below:

Greeting you received each time you arrived *

Poor Below Average Average Above Average Outstanding

Cleanliness of the facility *

Poor Below Average Average Above Average Outstanding

Friendliness, hospitality, and professionalism of staff *

Poor Below Average Average Above Average Outstanding

Satisfaction with your clinical care and the outcome of that care *

Poor Below Average Average Above Average Outstanding

How likely are you to recommend us to family and/or friends? *

Not at all Likely Slightly Likely Moderately Likely Very Likely Extremely Likely

How can we improve our services to better serve you? *

If you would like to leave a message for your Physical Therapist you may do so below. *

Thank you very much for input.

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