Patient Survey

Take our patient survey and receive a $5 Gift Card.

We feel your input is very important in providing great services and to know how we are doing! Please tell us about your patient experience at Functional Performance Center by answering the following questions.

Note: Gift cards are offered only to patients regarding a recent patient visit. Other restrictions may apply.

Your Name (required)*
Your Email (required)*
Your Physical Therapist (required)*
1. How was your overall experience when scheduling your appointments?
- Very Poor
- Poor
- Average
- Good
- Awesome
2. How was your question(s) or concern(s) handled by the front office staff?
- Very Poor
- Poor
- Average
- Good
- Awesome
3. Has the front office staff been professional and courteous towards you?
- Very Poor
- Poor
- Average
- Good
- Awesome
4. Were your insurance benefits/financial responsibility explained clearly to you?
- Very Poor
- Poor
- Average
- Good
- Awesome
5. How do you feel the clinical staff (therapists, assistants) addressed your primary physical therapy needs?
- Very Poor
- Poor
- Average
- Good
- Awesome
6. Did you receive an appropriate and clear Home Exercise Program?
- YES
- NO
7. If you have received physical therapy elsewhere, how does your treatment here compare?
- Very Poor
- Poor
- Average
- Good
- Awesome
8. How do you feel your overall experience has been with your primary physical therapist?
- Very Poor
- Poor
- Average
- Good
- Awesome
9. How was your overall experience with the staff at the Functional Performance Center?
- Very Poor
- Poor
- Average
- Good
- Awesome
10. What percentage did you improve while in therapy?
- 0-20%
- 21-40%
- 41-60%
- 61-80%
- 81-100%
If not optimal improvement, what could have improved?
Your Comments/Suggestions...
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(480) 968-2020

2065 S. Cottonwood Dr, Suite 1, Tempe, Arizona 85282

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