Acme Physical Therapy
Anonymous Survey
Help us get to know you better
Your answers help us take better care of patients like you.
Your privacy is protected
We do not ask for your name, email, phone, or birth date. We only see the totals from all patients — never just yours.
18 questions
About You
What is your age?
About You
What's your ZIP code?
This tells us where our patients live.
Enter your 5-digit ZIP code
How You Found Us
How did you first hear about us?
Who Sent You
Who sent you to us?
Start typing a name and pick from the list.
Your Experience
Have you been to physical therapy before?
Your Journey
How long did you wait before calling us?
Your Journey
What made you call now?
Your Choice
How many other PT clinics did you contact before us?
How You Booked
How did you book your first visit?
Your Care
What part of your body hurts or needs help?
Select all that apply.
Before Your First Visit
Did you look at our website before your first visit?
Before Your First Visit
Did you look at other PT clinics before choosing us?
Research
Did you use Google to learn about your problem?
Research
Did you use Google to find a PT clinic?
Research
Did you use an AI tool like ChatGPT or Gemini to learn about your problem?
Research
Did you use an AI tool to find a PT clinic?
Your Choice
What made you choose us?
Select all that apply.
Coverage
What kind of insurance are you using?
Thank you
Your answers help us take better care of every patient. Your care team will be with you soon.