Expressive Connections Visit Experience Survey
We would love to hear how your visit went today! Please share your feedback so that we may continue serving our community and continually improving the patient experience!
Sign in to Google to save your progress. Learn more
If you have had any billing questions or concerns, how satisfied are you with the assistance that you received?
Clear selection
I received a friendly greeting when I arrived
Clear selection
The front desk was able to help me with any questions or assistance needed
Clear selection
My therapy session today met my expectations
Clear selection
My therapist was able to answer my questions satisfactorily
Clear selection
I was given home exercises/tasks to complete in order to continue progressing toward my/my child's goals.
Clear selection
Is there anything you would like to bring to our attention from your time with us today?
Is there anyone who was especially helpful or you feel needs more training?
Name of person filling out the survey (optional):
Client's name (optional):
If you would like us to follow up with you, please provide the best way to reach you (i.e. phone number, email address - optional).
Have you had a truly wonderful experience? Share your experience with others and help us meet our mission  to inspire hope and improve the health, and well-being of our clients and families by providing a  positive, warm and supportive environment and the best care to each patient.
Google      Yelp
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Expressive Connections. Report Abuse