Patient Survey

We take our customer care very seriously. Pass Physical Therapy believes in taking a hard look at ourselves. We believe that by doing this we can see the company through your eyes. In our constant struggle to make this a better company please take time to fill out the following. Thank you for taking the time to send us the following information.

Patient Survey Form

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1. Age:   2.  Sex:     

3. General area of treatment  (circle all that apply):

Other (specify):

Please answer the questions below by selecting the response which best describes your opinions about your treatment.

 1. The office receptionist is courteous.          

2. The registration process is not appropriate.

3. The waiting area is comfortable (in terms of lighting temp, décor)

4.  My therapist did not spend enough time with me. 

5.  My therapist thoroughly explains the treatments I receive.

6.  My therapist treats me respectfully.        

7.  My therapist listens to my concerns.       

8.  My therapist did not answer all my  questions.        

9.  My therapist advises me on ways to avoid future problems. 

10. My therapist gives me detailed instructions regarding my home program. 

11 Overall, I am completely satisfied with the services I received from my therapist.

12. I would return to this office for future services or care. 

 

Enter any additional comments in the space provided below:

 

  

It may take a few moments before data is submitted.

Telephone:

Live Customer Care Center

1-951-769-0300
 Monday to Friday   7:30am to 5:30pm

Saturdays, Sundays and federal holidays please leave a message.  A customer representative will contact you within 24 hours of the first business day.

 
 
 
  Directions to Yucaipa Clinic:

Map of 34213 Yucaipa Blvd, Yucaipa CA 92399

 

 Directions to Beaumont Clinic:

Map of 1676 East 6th Street
Beaumont, CA 92223-2513, US

 Did you know:

Back Pain is the #1 problem treated at Pass Physical Therapy

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