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Patient Survey

At Full Potential Physical Therapy, we are constantly focusing on ways to improve our service to our patients and referring physicians. Please take a moment to let us know how well we are doing and what we can do to improve our services to you by completing this short survey.

Please rate the survey questions below based on the following scale.
4 = Excellent 3 = Good   2 = Fair   1 = Unacceptable   N/A = Not Applicable

  1. Your Physical Therapist
    1. Professionalism
      4321N/A
    2. Friendly/Helpful
      4321N/A
    3. Knowledge of your condition
      4321N/A
    4. Response to your questions/concerns
      4321N/A
    5. Punctuality
      4321N/A
  2. Therapist Support Staff – Morgan/Joel/Rae
    1. Friendly/Helpful
      4321N/A
    2. Attentive to your needs
      4321N/A
  3. Office Staff
    1. Friendly/Respectful
      4321N/A
    2. Appointment scheduling
      4321N/A
    3. Handling of insurance claims
      4321N/A
    4. Professionalism
      4321N/A
  4. Patient Care
    1. Did you accomplish your goals?
      4321N/A
    2. Were you fully educated on your condition?
      4321N/A
    3. Do you understand your home exercise program?
      4321N/A
    4. Would you recommend us to friends and family?
      4321N/A
    5. If future PT is needed, will you choose Full Potential?
      4321N/A
  5. Overall Satisfaction with Full Potential
    4321N/A
  6. Areas needing improvement:
  7. What were your limitations prior to physical therapy, and how have those changed as a result of coming to Full Potential? What can you do now that you could not do before coming to Full Potential?
  8. What are our Clinic Strengths?
  9. With your permission, Hanneken Full Potential would like to include Your Results and our Clinic Strengths in our public, electronic and written marketing promotions. Our marketing promotions include, but are not limited to, patient newsletters, doctors’ letters, as well as website and Facebook campaigns. Please sign below and indicate if the aforementioned is “okay” or “not okay” to use for our promotions.

    OKAY to use for promotionsNOT OKAY to use for promotions