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Knee - LCL MCL Sprain
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Plantar Fasciitis
Spine - Degenerative Disc
Degenerative Joint Disease
Leg Fracture or Stress Facture
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Patient Survey:
Please complete the following survey. We appreciate your feedback.
Questions with the red asterisk must be answered.
*
Indicates required field
How did you hear about In Motion Physical Therapy?
*
Physician
Family/Friend
Insurance
Advertisement
Drive-by
Other
If Other please specify:
*
How did you schedule your first appointment?
*
Phone
In Person
Through my Doctor
Through my Insurance
Other
If Other please specify:
*
What was the purpose of your visit (check all that apply)?
*
Head/Neck
Mid/Lower Back
Shoulder
Hand/Wrist/Elbow
Hip/Knee
Foot/Ankle
Gait/Balance
Posture/Flexibility
Cleanliness and general appearance of facility:
*
Very Clean and Welcoming
Somewhat Clean and Welcoming
Not so Clean nor Welcoming
Who was the Physical Therapist you saw for your initial evaluation?
*
Joanna Frantz, PT, MSPT, DPT
Kirsten Heath, PT, DPT, OCS
Other
If Other, please specify:
*
For each of the following questions, select the answer that best describes your experience.
How easy was it to make your first appointment?
*
Very Satisfied
Satisfied
Neutral
Unsatisfied
Very Unsatisfied
How easy was it to make your subsequent appointments?
*
Very Satisfied
Satisfied
Neutral
Unsatisfied
Very Unsatisfied
Front office staff was professional, courteous, and friendly.
*
Very Satisfied
Satisfied
Neutral
Unsatisfied
Very Unsatisfied
The helpfulness of the staff that assisted you with billing or insurance.
*
Very Satisfied
Satisfied
Neutral
Unsatisfied
Very Unsatisfied
The Physical Therapist was courteous and friendly.
*
Very Satisfied
Satisfied
Neutral
Unsatisfied
Very Unsatisfied
During the evaluation the Physical Therapist explained my treatment and plan and/or gave me future goals.
*
Very Satisfied
Satisfied
Neutral
Unsatisfied
Very Unsatisfied
The Physical Therapist gave me home exercises and proper instructions at the initial evaluation.
*
Very Satisfied
Satisfied
Neutral
Unsatisfied
Very Unsatisfied
The Physical Therapist was able to answer my questions about my condition.
*
Very Satisfied
Satisfied
Neutral
Unsatisfied
Very Unsatisfied
The Physical Therapist explained things in a way I could understand.
*
Very Satisfied
Satisfied
Neutral
Unsatisfied
Very Unsatisfied
How would you rate your overall experience at In Motion Physical Therapy?
*
Very Satisfied
Satisfied
Neutral
Unsatisfied
Very Unsatisfied
Other Comments
*
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Home
Location
Contact Us
Staff
Forms
Insurance
Facility
Services
In Motion Services
Physical Therapy Sessions
Massage Therapy Sessions
Common Conditions
>
Shoulder
>
Rotator Cuff Tendonitis
Rotator Cuff Repair
Acromioplasty
Shoulder Impingement Syndrome
Shoulder Instability
Hip
>
Total Replacement
Bursitis
Groin Strain
Hip - Labral Tear / Repair
Knee
>
Patellar Tendonitis
Chondromalacia
ACL/PCL Reconstruction
Total Knee Replacement
Knee - IT Band Syndrome
Knee - LCL MCL Sprain
Ankle / Foot
>
Achilles
Jones Fracture
Plantar Fasciitis
Spine - Degenerative Disc
Degenerative Joint Disease
Leg Fracture or Stress Facture
Testimonials
Patient Survey
Favorite Links
For Sale
News!