Performing Arts Physical Therapy's

IN THE HEART OF BROADWAY
TAKING CARE OF BROADWAY

Performing Arts Physical Therapy's Patient Survey

Completed anonymously by patients who are presently receiving physical therapy services, or have previously been a patient at PAPT

Performing Arts Physical Therapy, PC. - 311/315 west 43^rdStreet, Suite 405 New York, NY 10036

Dear patient: Thank you for taking a few minutes of your valuable time to complete this brief questionnaire so that PAPT can continue to try to provide the best physical therapy services in New York City. Your feedback provides PAPT with essential information about the quality and consistency of the care provided to you by all of our staff. All responses are confidential. To preserve your anonymity, please do not include your name.

Part I - Individual Information & current/previous experience at Performing Arts Physical Therapy.

Age	Gender	Dancer
	Female Male	Yes No

Musician	Actor	Highest Level of Education / Training
Yes No	Yes No

Is this your first encounter with physical therapy? Are you presently a patient at PAPT?
Yes No	Yes No

Number of times you have been a patient at PAPT?

Most recent visit (month/year):

Approximate Total # of injuries you have had as a performer:

Part II - General quality of service being provided at PAPT

Instructions: Below is a list of statements that relate to various quality of services and physical therapy care provided at Performing Arts Physical Therapy. Please read each one carefully. After each item, check the statement to the right that best describes how you feel about the service provided as related to your experience with us at PAPT.

Quality of Office Services Provided at PAPT	Excellent	Good	Adequate	Insufficient
The front desk staff was helpful?
The front desk staff was respectful?
The front desk staff was courteous?
The physical therapy schedule was adequate for my needs?
The phone skills for the front desk staff are:
All my insurance questions were answered properly?
I was given all the information I needed for my first visit?
I was able to contact someone during regular business hours?
I was able to schedule an appointment that fit my schedule?
I was able to schedule all of my appointments.
The front desk staff Introduced themselves on the phone
The front desk staff introduced themselves when I first arrived
All my questions and concerns were answered appropriately
The office was clean.
The bathroom was clean and well stocked with necessary items.
The billing procedures were explained by the front desk staff


Please give us your overall impression of PAPT
Would you refer a friend to PAPT? Please tell us why or why not

Quality of Physical Therapy Services Provided at PAPT	Excellent	Good	Adequate	Insufficient
My physical therapist was helpful?
My physical therapist was respectful?
My physical therapist was courteous?
When I arrived for my appointment the session was started on time
The communication skills of my PT were?
The evaluation skills of my PT were?
The hands on skills of my PT were?
The exercise knowledge of my PT was?
My PT involved me in the decision making in my plan of care.
My PT was in contact with my doctor about my program and care
The home exercise program I was Given was?
The information I was given on preventing my injury again was?
The confidence I had in my PT was
The trust I had in my PT was?
My ability to consistently see my therapist was?
My privacy was was protected during treatment
My over all satisfaction
My over all comfort level at PAPT
Was there any one person at PAPT that you would like to tell us about and what they did that impressed you.
Is there anything that you would like to tell us that will help in providing you with better service or care? Please let us know as your ideas, thoughts and concerns are a valuable tool that we use to ensure that we provide the best care in New York City for Physical Therapy Services.