Opinion meter tool

1. Please indicate how long you have been in therapy.

1. 10 days or less
2. more than 10 days

2. How satisfied are you with the competence of your therapist?

1. Very Satisfied
2. Satisfied
3. Unsatisfied
4. Very unsatisfied

3. Is your therapist(s) kind, courteous, and supportive?

1. Yes
2. No

4. How satisfied are you with the way your treatment was explained?

1. Very Satisfied
2. Satisfied
3. Unsatisfied
4. Very Unsatisfied

5. How satisfied are you with the assistance you receive from the front desk staff?

1. Very Satisfied
2. Satisfied
3. Unsatisfied
4. Very Unsatisfied

6. Are the front desk and support staff kind, courteous, and supportive?

1. Yes
2. No

7. Are you satisfied that therapy has been beneficial in improving your condition?

1. Very Satisfied
2. Satisfied
3. Unsatisfied
4. Very Unsatisfied

8. Would you recommend outpatient therapy at the Physical Rehab and Sports Injury Center to others?

1. Yes
2. No

9. What is your therapist’s name: (please enter 2-digit number, as shown before therapist’s name).

Source: Provena St. Joseph Physical Rehab & Sports Injury Center, Joliet, IL.