Functional Performance Center
2065 S. Cottonwood, Suite 1
Tempe, Arizona 85282
Tel: (480) 968-2020

Please rate the following questions based on your experience at The Functional Performance Center: 1=Very Poor, 2= Poor, 3= Average, 4=Good, 5= Very Good

Name:
Physical Therapist:
How is your overall experience when scheduling your appointments? 1 2 3 4 5
How was your question(s) or concern(s) handle by the front office staff? 1 2 3 4 5
Has the front office staff been professional and courteous towards you? 1 2 3 4 5
Were your insurance benefits/financial responsibility explained clearly to you? 1 2 3 4 5
How do you feel the clinical staff (therapists, assistants) addressed your primary physical therapy needs? 1 2 3 4 5
Did you receive an appropriate and clear Home Exercise Program?   YES NO
If you have received physical therapy elsewhere, how does your treatment here compare? 1 2 3 4 5
How do you feel your overall experience has been with your primary physical therapist? 1 2 3 4 5
How was your overall experience with the staff at the Functional Performance Center? 1 2 3 4 5
Comments/Suggestions: