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2005
July
T
Test Survey
Test Survey
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Hello:
You are invited to participate in our survey [Project Description Here]. In this survey, approximately [Approximate Respondents] people will be asked to complete a survey that asks questions about [General Survey Process]. It will take approximately [Approximate Time] minutes to complete the questionnaire.
Your participation in this study is completely voluntary. There are no foreseeable risks associated with this project. However, if you feel uncomfortable answering any questions, you can withdraw from the survey at any point. It is very important for us to learn your opinions.
Your survey responses will be stricly confidential and data from this research will be reported only in the aggregate. Your information will be coded and will remain confidential. If you have questions at any time about the survey or the procedures, you may contact [Name of Survey Researcher] at [Phone Number] or by email at the email address specified below.
Thank you very much for your time and support. Please start with the survey now by clicking on the
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The therapist presented himself in an organized, professional manner.
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
The therapist provided enough education to help me understand my condition and source of pain.
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
Additional Comments/Suggestions for improvement
I felt that the therapist provided a relaxing and comfortable rehab environment.
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
The therapist spent enough time with me personally during each treatment session.
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
The therapist communicated with me and any third parties involved (i.e. Workers Compensation Board, Family Doctor etc.) in a timely and effective manner.
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
Ther therapist spent enough time teaching and reviewing the exercises I had to do at home.
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
I would recommend this therapist to a friend or family member
Yes
No
Please contact
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if you have any questions regarding this survey.
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