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? *

Paso Robles Lake Nacimiento Atascadero 2 or more clinics

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

Very Satisfied Satisfied Neutral Unsatisfied Very Unsatisfied

Which Therapist(s) did you see? *

Tony Wallace Wendy Westphal Emily Hernandez Janev Alvarez Alyson Huber Jennifer Metzler Brenda Mendoza Meghan Alonso Melissa Rasmussen Donna Randall

Check all that apply

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.

Submit

Subscribe to our Newsletter

* Indicates required field

Email *