MedStar Health Survey Questionnaire Patient Name(Required) First Last Date of Birth(Required) MM slash DD slash YYYY Gender(Required)MaleFemalePrefer not to sayWho did you contact when you requested services?(Required) Jenna Page Other MedStar provider 888-44-SPORT Did you go to a MedStar Health Urgent Care?(Required) Yes No Which location did you visit?(Required) Did you attend physical therapy?(Required) Yes No Which location did you visit?(Required) What was the name of the PT?(Required) What months did you go?(Required) Did you or a family member use any other MedStar Health services?(Required) Yes No What other services did you or your family member use?(Required) What was your reasoning for visiting MedStar Health? Who was the doctor that you saw? Were you referred to any services?(Required) Physical Therapy Occupational Therapy Imaging X-Rays Rehabilitation Plan Surgery Urgent Care Other Would you return to MedStar Health in the future?(Required) Yes No Were you satisfied with your experience at MedStar Health?(Required) Yes No How would you rate your overall experience?(Required) Very Bad Bad Average Good Very Good Would you recommend MedStar Health to others?(Required) Yes No Additional comments on your experience Is there any topics that you would be interested in learning more about through MedStar Health's educational events & resources (Head, Heat, Heart)? Any other recommendations for MedStar Health?(Required)
