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Patient Satisfaction Survey
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Welcome to California
Rehab Specialist/ Seersoft Inc.
We value your visit and will do our utmost to ensure the best treatment and comfort.
Your evaluation of our office and staff would be appreciated, as our patients' satisfaction is the only true measure of our performance. It is through your comments that we can tell if we are meeting your needs and expectations. Please take a few moments to complete this form.
Thank you for choosing California Rehab Specialist/ Seersoft, Inc.
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Name
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First
Last
Date
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Address
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Line 1
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City
State
Zip Code
Country
Cell
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Business
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Email
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Receptionist
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Office Staff / Friendliness/ Efficiency
Physical Therapist
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Office Management
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Office Staff / Friendliness/ Efficiency
Reception/Waiting Area
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Quality of Service /Cleanliness
Exams/Treatment Rooms
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Quality of Service /Cleanliness
Treatment Tables/Equipment
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Quality of Service /Cleanliness
Physical Therapy/Massage
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Quality of Service /Cleanliness
Maintenance
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Quality of Service /Cleanliness
Towel Supplies
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Quality of Service /Cleanliness
How would you rate our office?
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Overall Service
How would you rate our office cleanliness
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Overall Service
How would you rate the quality of patient care?
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Overall Service
Was your visit comfortable?
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No
Would you recommend your friends and family?
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Yes
No
Would you return?
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Yes
No
How did you hear about this site?
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If Other please specify:
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COMMENTS/SUGGESTIONS:
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