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Menu
Home
About Us
About Us
Why REHAB AT WORK?
Managers
Careers
Resources
Services
Physical Therapy
Occupational Therapy
Functional Capacity Evaluation (FCE)
Work Hardening/Conditioning Program
Work Site Services
Telehealth
Locations
Alexandria
Baltimore
Columbia
Corporate Office
Frederick
Glen Burnie
Herndon
Lanham
Manassas
Pikesville
Rockville
Waldorf
For Patients
Patient Forms
Billing and Insurance
Frequently Asked Questions
Refer a Patient
Client Feedback Questionnaire Frederick
Dear REHAB AT WORK Client: In order to provide the most complete report possible, with the most appropriate recommendations, we ask that you contact our office the business day following your appointment, during our regular hours (8:00 - 4:00 pm), to inform us of your body response as well as to address any other questions you might have. Please follow the instructions given to you today by your therapist. We want you to know that " It's Your RESULTS That MATTER" and our mission is "To keep the care in healthcare by always putting people first". In order to follow through with our mission, we are asking you to take a few moments to fill out this confidential questionnaire. Please feel free to place it in the suggestion box in the waiting room or mail it directly to our corporate office: REHAB AT WORK - Corporate Attn: Shannon Hart 51 Monroe Street, Suite 1207 Rockville, Maryland 20850
What have you learned from this visit that will help you plan for return to employment/and or improving your lifestyle?
Please select the clinic you attended
Alexandria
Baltimore
Columbia
Frederick
Glen Burnie
Lanham
Manassas
Pikesville
Rockville
Waldorf
Please rate your degree of satisfaction to the following
I feel that my privacy was always respected during my visit
Strong Agree
Agree
Indifferent
Disagree
Strongly Disagree
I feel that throughout my visit, procedures were appropriately explained to me
Strong Agree
Agree
Indifferent
Disagree
Strongly Disagree
I feel throughout my visit, my questions were answered thoroughly and promptly
Strong Agree
Agree
Indifferent
Disagree
Strongly Disagree
I would recommend my therapist to family and friends
Strong Agree
Agree
Indifferent
Disagree
Strongly Disagree
The overall quality of my visit was excellent
Strong Agree
Agree
Indifferent
Disagree
Strongly Disagree
The front office staff was professional and courteous towards me
Strong Agree
Agree
Indifferent
Disagree
Strongly Disagree
The clinical staff was professional and courteous towards me
Strong Agree
Agree
Indifferent
Disagree
Strongly Disagree
The appearance of the clinic was clean and organized
Strong Agree
Agree
Indifferent
Disagree
Strongly Disagree
The clinic was conveniently located to my home/work
Strong Agree
Agree
Indifferent
Disagree
Strongly Disagree
Parking was readily available to me
Strong Agree
Agree
Indifferent
Disagree
Strongly Disagree
The clinic had the appropriate equipment/supplies for my needs
Strong Agree
Agree
Indifferent
Disagree
Strongly Disagree
I would recommend this facility to family and friends
Strong Agree
Agree
Indifferent
Disagree
Strongly Disagree
Additional Comments
Therapist's Name
Your Name (Optional)
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Last Name
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Email