Patient Survey - Creating Pathways

Patient’s age

Newborn – 3 years

3 years-8 years

8 years – 13 years

13 years -18 years

How did you learn about this practice (check all that apply)

Physician

Friend

Social Media

Google Search

Former Patient’s Family

Other

Was this your first experience with OT/SLP therapy?

Yes

No

Was this your first experience with this practice?

Yes

No

For what reason did your child receive therapy services?

How would you rate our overall customer service?

How easy was it to make an initial appointment?

Were all staff members courteous?

How was the convenience of the building location?

How is the building accessibility?

Making you feel welcome?

Helpfulness?

Professionalism?

Respectfulness?

Thoroughness of obtaining all necessary information?

Friendliness?

Promptness of greeting for scheduled appointment?

Maintaining your/your child’s privacy?

Listening to you/your child’s needs/concerns?

Providing an adequate home program?

Additional Comments and Suggestions