Patient Discharge Survey

Schuylkill Rehabilitation Center is committed to providing high quality therapy services. We wish to obtain your assessment of our services in order to help meet these high standards. We would be more than grateful if you could complete the following questionnaire.

Please check the services you received:

Check each question in a rating from 1(Never) to 7(Always):

1. Was your first visit for the evaluation scheduled promptly?
   

   Never				Always
   1	2	3	4	5	6	7

   
   
2. Were your phone inquiries handled in a pleasant and professional manner?
   

   Never				Always
   1	2	3	4	5	6	7

   
   
   
3. Did you feel welcome and treated courteously at the time of your admission?
   

   Never				Always
   1	2	3	4	5	6	7

   
   
   
4. Was your billing information adequately explained to you?
   

   Never				Always
   1	2	3	4	5	6	7

   
   
   
5. Was the evaluation of your condition thorough?
   

   Never				Always
   1	2	3	4	5	6	7

   
   
   
6. Were you asked for input on your goals and treatment plan?
   

   Never				Always
   1	2	3	4	5	6	7

   
   
7. Were your suggestions discussed and questions answered to your satisfaction?
   

   Never				Always
   1	2	3	4	5	6	7

   
   
8. Was your privacy respected?
   

   Never				Always
   1	2	3	4	5	6	7

   
   
9. Was your treatment and or types of exercises explained to you?
   

   Never				Always
   1	2	3	4	5	6	7

   
   
10. Did you feel your therapist(s) were knowledgeable and skilled?
    

    Never				Always
    1	2	3	4	5	6	7

    
    
11. Did the therapist consider the day to day status of your condition?
    

    Never				Always
    1	2	3	4	5	6	7

    
    
12. Did the therapist motivate and encourage you during treatment?
    

    Never				Always
    1	2	3	4	5	6	7

    
    
13. Was the therapist courteous, thoughtful, and helpful and did they show genuine interest in your problem?
    

    Never				Always
    1	2	3	4	5	6	7

    
    
14. Were you treated promptly at your scheduled time?
    

    Never				Always
    1	2	3	4	5	6	7

    
    
15. Were conversations/interactions professional during treatment time?
    Staff to Patient:

    Never				Always
    1	2	3	4	5	6	7

    
    Staff to Staff:

    Never				Always
    1	2	3	4	5	6	7

    
    Patient to Patient:

    Never				Always
    1	2	3	4	5	6	7

    
    
16. Did the staff provide you with appropriate instructions to be carried out at home?
    

    Never				Always
    1	2	3	4	5	6	7

    
    
17. How would you rate the overall satisfaction with the results of your treatment?
    

    Never				Always
    1	2	3	4	5	6	7

    
    
18. Would you return to us for treatment in the future if needed?
    

    Never				Always
    1	2	3	4	5	6	7

    
    
19. Would you recommend us to a friend or relative?
    

    Never				Always
    1	2	3	4	5	6	7