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Patient Discharge Survey

Schuylkill Rehabilitation Center is committed to providing high quality therapy services. We wish to obtain your assessment of our services in order to help meet these high standards. We would be more than grateful if you could complete the following questionnaire.

Please check the services you received:

P.T. O.T. Speech
Workinetics Psychology Orthotics
Prosthetics Other:


Check each question in a rating from 1 (Never) to 7 (Always):

  1. Was your first visit for the evaluation scheduled promptly?
    Never   Always
    1   2   3   4   5   6   7

  2. Were your phone inquiries handled in a pleasant and professional manner?
    Never   Always
    1   2   3   4   5   6   7

  3. Did you feel welcome and treated courteously at the time of your admission?
    Never   Always
    1   2   3   4   5   6   7

  4. Was your billing information adequately explained to you?
    Never   Always
    1   2   3   4   5   6   7

  5. Was the evaluation of your condition thorough?
    Never   Always
    1   2   3   4   5   6   7

  6. Were you asked for input on your goals and treatment plan?
    Never   Always
    1   2   3   4   5   6   7

  7. Were your suggestions discussed and questions answered to your satisfaction?
    Never   Always
    1   2   3   4   5   6   7

  8. Was your privacy respected?
    Never   Always
    1   2   3   4   5   6   7

  9. Was your treatment and or types of exercises explained to you?
    Never   Always
    1   2   3   4   5   6   7

  10. Did you feel your therapist(s) were knowledgeable and skilled?
    Never   Always
    1   2   3   4   5   6   7

  11. Did the therapist consider the day to day status of your condition?
    Never   Always
    1   2   3   4   5   6   7

  12. Did the therapist motivate and encourage you during treatment?
    Never   Always
    1   2   3   4   5   6   7

  13. Was the therapist courteous, thoughtful, and helpful and did they show genuine interest in your problem?
    Never   Always
    1   2   3   4   5   6   7

  14. Were you treated promptly at your scheduled time?
    Never   Always
    1   2   3   4   5   6   7

  15. Were conversations/interactions professional during treatment time?
    Staff to Patient:
    Never   Always
    1   2   3   4   5   6   7

    Staff to Staff:
    Never   Always
    1   2   3   4   5   6   7

    Patient to Patient:
    Never   Always
    1   2   3   4   5   6   7

  16. Did the staff provide you with appropriate instructions to be carried out at home?
    Never   Always
    1   2   3   4   5   6   7

  17. How would you rate the overall satisfaction with the results of your treatment?
    Never   Always
    1   2   3   4   5   6   7

  18. Would you return to us for treatment in the future if needed?
    Never   Always
    1   2   3   4   5   6   7

  19. Would you recommend us to a friend or relative?
    Never   Always
    1   2   3   4   5   6   7

Please comment on additional suggestions to improve our quality of services:
 
Optional:
Name: Phone: