Integrated Rehab | Patient Experience Survey

PLEASE ENTER YOUR THERAPIST'S NAME (OPTIONAL):

PLEASE ENTER YOUR NAME (OPTIONAL):

The Services received from Integrated Rehab Professionals were:*

Physiotherapy
Occupational Therapy
Social Worker
Dietitian

Integrated Rehab Professionals would like you to give us your opinion about your therapist. Please complete it here. We would like to have your input as to how well our therapists provide treatment so that we can improve our program.

We are interested in your honest opinion, whether it be positive or negative. Would you please answer a few questions for us. Your name will be kept confidential.

Part A

Do you agree or disagree with the following statements?

Your therapist was courteous and respectful.*

Yes
No

Your therapist took your problems very seriously.*

Yes
No

Your therapist provided services as often as you needed them.*

Yes
No

Your therapist listened to your problems.*

Yes
No

Your therapist tried to help you as much as he/she could.*

Yes
No

Your therapist always explained things thoroughly.*

Yes
No

Your therapist used her time wisely when he/she treated you.*

Yes
No

Your therapist involved you in making treatment decisions.*

Yes
No

Your therapist helped you to function at the best level you could considering your health problems*

Yes
No

If you were to seek help again you would return to our services or recommend them to a friend.*

Yes
No

Your cultural and religious needs were respected.*

Yes
No

Part B

How do you think your therapist could improve?*

Part C

To what extent has the treatment and consultation been helpful?*

Very helpful
Mostly helpful
Somewhat helpful
Not helpful

In an overall sense, how would you rate the therapy service received.*

Very satisfied
Mostly satisfied
Somewhat satisfied
Not satisfied

Part D

We are interested in knowing how you are doing since you last saw your therapist.

How many falls have you had, if any?*

How many times have you had to go to a hospital emergency department?*

How many times have you been admitted into the hospital?*

Overall, how would you describe your current mobility and independence with every day activities?*

If you feel that your health is declining, please consider a follow up appointment with your family doctor to review your health care needs or telephone IRP at the number below.

If you would like to speak to someone about community resources or private therapy services please contact our office at 1-888-462-4849 ext 222.

ANGELA DYE

Director, Integrated Rehab Professionals

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Patient Experience Survey

Part A

Part B

Part C

Part D

ANGELA DYE

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