Ullucci Sports Medicine
& Physical Therapy, Inc.
Patient Satisfaction Survey
Please select the name of the staff member you worked with : Select one Paul A. Ullucci, Jr., PT Lori S. Dacosta, PT Kaitlin Riggs, PT Jason Price, ATC, CSCS Joseph Cassinelli, PT Debbie Luis - Secretary Jessica Alves - Secretary Tim Crandal, ATC Allison Fisher, ATC Donald Squires, ATC Susan Rotsky. ATC I recieved select one Physical Therapy Pesonal Training Sports Specific Training Athletic Training Services Massage Our Secretarial Staff : I was greeted an a friendly professional manner disagree somewhat disagree agree somewhat agree strongly agree The front desk staff explained my copay and/or deductible to me : disagree somewhat disagree agree somewhat agree Strongly agree Our Medical Staff : The staff member appeared interested in my health and well being : disagree Somewhat disagreee Agree Strongly agree The staff member spent sufecient amount of time with me during my treatment Disagree somewhat disagree agree Strongly agree The staff member insured that I achieved my personal goals Disagree Somewhat disagree Agree Strongly agree The facilities : The clinic was clean and well maintained Disagree Somewhat Disagree agree Strongly Agree The equipment was readily availble for my use Disagree somewhat disagree Agree Strongly Agree Please enter any additional comments or suggestion below All responses will be kept confidential and you will not be contacted unless you have indicated that you would like us to. Check here if you would like us to contact you regarding your survey (make sure you have provided us your email or phone number below) Please Enter me into the Quarterly Raffle (make sure you have provided us your email or phone number below) Your name : (optional) Phone Number : (optional) Please enter your email (optional)
Please select the name of the staff member you worked with : Select one Paul A. Ullucci, Jr., PT Lori S. Dacosta, PT Kaitlin Riggs, PT Jason Price, ATC, CSCS Joseph Cassinelli, PT Debbie Luis - Secretary Jessica Alves - Secretary Tim Crandal, ATC Allison Fisher, ATC Donald Squires, ATC Susan Rotsky. ATC
I recieved select one Physical Therapy Pesonal Training Sports Specific Training Athletic Training Services Massage Our Secretarial Staff : I was greeted an a friendly professional manner disagree somewhat disagree agree somewhat agree strongly agree The front desk staff explained my copay and/or deductible to me : disagree somewhat disagree agree somewhat agree Strongly agree Our Medical Staff : The staff member appeared interested in my health and well being : disagree Somewhat disagreee Agree Strongly agree The staff member spent sufecient amount of time with me during my treatment Disagree somewhat disagree agree Strongly agree The staff member insured that I achieved my personal goals Disagree Somewhat disagree Agree Strongly agree The facilities : The clinic was clean and well maintained Disagree Somewhat Disagree agree Strongly Agree The equipment was readily availble for my use Disagree somewhat disagree Agree Strongly Agree Please enter any additional comments or suggestion below All responses will be kept confidential and you will not be contacted unless you have indicated that you would like us to. Check here if you would like us to contact you regarding your survey (make sure you have provided us your email or phone number below) Please Enter me into the Quarterly Raffle (make sure you have provided us your email or phone number below) Your name : (optional) Phone Number : (optional) Please enter your email (optional)
I recieved select one Physical Therapy Pesonal Training Sports Specific Training Athletic Training Services Massage
I was greeted an a friendly professional manner disagree somewhat disagree agree somewhat agree strongly agree The front desk staff explained my copay and/or deductible to me : disagree somewhat disagree agree somewhat agree Strongly agree
The staff member appeared interested in my health and well being : disagree Somewhat disagreee Agree Strongly agree
The staff member spent sufecient amount of time with me during my treatment Disagree somewhat disagree agree Strongly agree
The staff member insured that I achieved my personal goals Disagree Somewhat disagree Agree Strongly agree
The clinic was clean and well maintained Disagree Somewhat Disagree agree Strongly Agree The equipment was readily availble for my use Disagree somewhat disagree Agree Strongly Agree
Please enter any additional comments or suggestion below All responses will be kept confidential and you will not be contacted unless you have indicated that you would like us to. Check here if you would like us to contact you regarding your survey (make sure you have provided us your email or phone number below) Please Enter me into the Quarterly Raffle (make sure you have provided us your email or phone number below) Your name : (optional) Phone Number : (optional) Please enter your email (optional)
Check here if you would like us to contact you regarding your survey (make sure you have provided us your email or phone number below)
Please Enter me into the Quarterly Raffle (make sure you have provided us your email or phone number below)
Your name : (optional)
Phone Number : (optional) Please enter your email (optional)