Please enter your name:

Please indicate how long you received treatment:

How would you describe the effectiveness of your treatment?

How would you rate the staff at Premier Rehab?

Please indicate your reason for treatment Sports injury Post-surgery Occupational Injury Other Please rank the following services (1-poor, 2-ok, 3-average, 4-good, 5-exceptional) 1 2 3 4 5 Overall treatment satisfaction 1 2 3 4 5 Atmosphere & facilities 1 2 3 4 5 Available equipment 1 2 3 4 5 Scheduling flexibility 1 2 3 4 5 Clinicians' attitude 1 2 3 4 5 Receptionists' attitude Would you recommend Premier Rehab to your friends and/or family? yes no

Please enter any additional comments below.

Comments: