Rehabilitation in Motion Comox Valley

CLIENT SATISFACTION QUESTIONNAIRE

We would appreciate if you would take a few moments to fill out our 'Client Satisfaction Questionnaire'. Your constructive feed back is helpful to us. Please trust that we will protect your privacy and that this information will be only used by Rehabilitation in Motion to improve our customer service.


Today's Date
Your Name *Required
Would you like us to contact you? Yes No *optional
Phone *optional
Email *optional
Type of Service Received Physio       Chiropractic       Massage       Exercise Therapy
Where did you receive treatment Port Alberni       Courtenay       Campbell River

Please rate the degree of satisfaction you experienced with our services


1. I was treated promptly and courteously by the reception staff
Disagree

Neutral

Agree
2. I was treated promptly and courteously by my therapist
Disagree

Neutral

Agree
3. My Intake Assessment form(s) were easy to complete
Disagree

Neutral

Agree
4. My therapist took a detailed history of my condition during my first visit
Disagree

Neutral

Agree
5. My therapist did a thorough physical assessment relative to my injury
Disagree

Neutral

Agree
6. I was provided with education regarding my injury and the recovery process
Disagree

Neutral

Agree
7. My treatment goals were discussed with me
Disagree

Neutral

Agree
8. I was provided with advice and encouragement about getting back to work
and/or to my usual activities, sports, hobbies and recreational activities
Disagree

Neutral

Agree
9. My questions and concerns were addressed in a timely and appropriate manner
Disagree

Neutral

Agree
10. I would refer a member of my family or a friend to Rehabilitation in Motion
Disagree

Neutral

Agree

Additional comments

How could we improve our service