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Patient Survey

Dear valued patient:

Thank you for choosing St. Francis Rehabilitation and Sports Medicine services for your care. We value your opinion of our services and would like your feedback. Our goal is to optimize your experience with us and provide the best quality care for our patients.

Please assist us with this goal by sharing your opinion of your experience while under our care. Your answers are anonymous and intended to use as a tool to best serve you.

This survey is completely optional and may be taken home with you to complete if you prefer. Our reception staff can provide you with a self-addressed stamped envelope for your convenience.

Please circle the most appropriate answer for each question and provide any additional comments in the sections provided.

  • E- Excellent
  • VG- Very Good
  • G-Good
  • F-Fair
  • P-Poor
How would you rate St. Francis Rehab and Sports Medicine on the following?

  1. Overall experience with front desk/reception area:

    Specific Comments:

  2. Explanations provided by the staff regarding: scheduling expectations, explanation of your condition, exercises, home program, and goals for therapy:

    Specific Comments:

  3. I would return to St. Francis Rehab and Sports Medicine for further future therapy services:
  4. I would recommend St. Francis Rehab and Sports Medicine to others for their rehab care:

If you would like to be contacted by a St. Francis Rehab and Sports Medicine manager, please complete the following information:
Name: Contact Number:

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