Online-Patient-Survey Date Date Format: MM slash DD slash YYYY My email address is Please check the percent improvement you experienced with treatment.No Better25-50%51-75%76-100%How soon were you able to make your first appointment?Same dayWithin 2 daysWithin 1 weekWithin 2 weeksCheck the box that best describes your experience as it relates to the questions below.What did we do well with your care? (please write your comments in the box below)What could we have done better? (please write your comments in the box below)Would you use us again?YesNoWould you recommend us to a friend?YesNoReceiving the Rakita Tomsic PT monthly newsletter on fitness, injury prevention, and physical therapy makes me more likely to use you in the future. (check the response that is most appropriate)YesNoI don’t get your newsletter but would like to receive it. This iframe contains the logic required to handle Ajax powered Gravity Forms.