How Are We Doing?

In general, what is the quality of your health?

How would you rate our concern for your Privacy?

How did you schedule your appointment?

How satisfied were you with getting your appointment scheduled when you wanted?

How long did it take you to get your appointment scheduled?*

Was our staff member who scheduled your appointment courteous and helpful?

How would you rate the professionalism of the Staff at our Reception Desk?*

How long did you have to wait in our reception area beyond your scheduled appointment time?

How would you rate the competence of our Technician who helped you?

How would you characterize the concern our Technician showed for your problem?

Mark the boxes that characterize the demeanor of your Therapist: *

How would you rate the competence of your Therapist?*

Did you get to meet with the Therapist you wanted? *

Were all your questions answered to your satisfaction?*

How would you rate the overall cleanliness of our clinic?*

Would you recommend MPTS to your friends or family members?*

Additional Feedback ... Would you like to tell us any other areas in which you feel our service could be improved:

Would you like somebody from our office to contact you?

Name (Optional)

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Phone

Which Clinic did you receive treatment at?

How long has it been since your last visit?

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