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Patient Outcomes

 

Without a doubt, the most important objective we have as a health clinic is to offer you the best possible care available. Our goal is that you leave our facility in a better state of overall health than you were when you first arrived.

Without quality care and a quality program, our success would be severely limited.

To maintain those very high standards, it is very important we have your feedback. Specifically, we need to know how you felt before you became a patient, and how you felt after you left the program. This will help us to improve our overall care, and to guarantee that future patients receive the same high quality service we've provided you.

Please take the time to fill out the questionnaire below.

Your First Name
Your Last Name
Evaluation Date (MM/DD/YYYY)
Your Age
Your Gender
Your Education
Your Ethnic Background
Your Language
Are you pregnant?
Do you smoke?
What type of therapy did you receive?
What is your present diagnosis?

(Please hold down the Control button to select more than one.)
What is your work status?
What is your discharge date? (MM/DD/YYYY)
Do you have problems socializing due to your injury?
Do you have problems concentrating due to your injury?

What is your level of perceived improvement?

 
Who was your primary therapist?
How many visits did you have?
What was the duration of your therapy? (in weeks)
 

Please fill in any comments you'd like to make about your therapy sessions here:

 

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