SURVEY

  • We value your feedback. Please complete the following brief survey or call us at (703) 242-4263 if you would like a paper form.

EASE OF GETTING CARE:

  • Ability to get in to be seen:

  • Hours Center is open:

  • Convenience of Center's location:

  • Prompt return on calls:

WAITING:

  • Time in waiting room:

THERAPIST:

  • Listens to you:

  • Takes enough time with you:

  • Explains what you want to know:

  • Gives you good advice and treatment:

  • Overall, how satisfied are you with your Therapist?

BILLING STAFF:

  • Friendly and helpful to you:

  • Answers your questions:

PAYMENT:

  • What you paid:

  • Explanation of charges:

  • Collection of payment:

FACILITY:

  • Neat and clean building:

  • Ease of finding where to go:

  • Comfort and Safety while waiting:

  • Privacy:

CONFIDENTIALITY:

  • Keeping my personal information private:

  • The likelihood of referring your friends and relatives to us:

  • What do you like best about our center?

  • What do you like least about our Center?

  • Suggestions for improvement?

  • Your First & Last Name & Relationship to Patient (First & Last Name):