* 1. How likely are you to recommend physiotherapist to family or friends?

* 2. During your most recent visit, did physiotherapist seem to know the important information about your medical history?

* 3. During your most recent visit, did physiotherapist give you easy to understand information about these health questions or concerns?

* 4. During your most recent visit, did physiotherapist listen carefully to you?

* 5. During your most recent visit, did physiotherapist explain things in a way that was easy to understand?

* 6. Overall, are you satisfied with your physiotherapist, neither satisfied nor dissatisfied with him, or dissatisfied with him?

* 7. How much do you trust your physiotherapist to make medical decisions that are in your best interests?

* 8. Are you male or female?

* 9. During your most recent visit, did your physiotherapist spend enough time with you?

* 10. Using any number from 0 to 10, where 0 is the worst health care possible and 10 is the best health care possible, what number would you use to rate all your health care in the last 12 months?

  10 Best health care possible 9 8 7 6 5 4 3 2 1 0 Worst health care possible
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