Diamond Physical Therapy - How Was Your Visit?

How Was Your Visit to Diamond Physical Therapy?

We appreciate you. We Also Thank You for Choosing Diamond Physical Therapy to Help You with your Recovery & Rehabilitation. The Best Thank You we Receive from our Current & Former Patients are the Referrals of Their own Family, Friends, Co-workers, or Neighbors.

Name or Initials (Optional):

Email (Optional):

Why were your referred to physical therapy?

How did you hear about us?
Returning Patient
Referred by Former Patient
Doctor Referral
Insurance Company
Marketing or Advertising
Other (please specify below)
Other Referral:

How long did you have to wait for someone to explain to you your insurance benefits?
1st Visit
2nd Visit
3rd Visit
Never Explained

Did you have any misunderstanding regarding your insurance benefits?
Yes
No

Once completing the appropriate forms, how long did you have to wait before being seen by your physical therapist?
Under 10 Minutes
10 - 15 Minutes
15 - 20 Minutes
20 - 30 Minutes

Are you satisfied with the overall care provided by your physical therapist?
Yes
No

If you answered "No" to the above question, how could we improve?

Now that you are no longer receiving physical therapy treatments, do you feel you problem or complaint has been:
Greatly Improved
Improved
Somewhat Improved
Not Improved
Worsened

Would you consider our office for any future services?
Yes
No

What could be better?

Are there any successes you would like to share?

I authorize Diamond Physical Therapy to use my name, photograph and any testimonials I made for publication purposes:
Yes
No

Experience the Diamond Difference
1406 E. Algonquin Rd ~ Algonquin, IL 60102 ~ Office: 847-854-0196 ~ Fax: 847-854-0197 ~ info@dptrehab.com