Growing Younger Physiotherapy Feedback Form

Feedback

Name
First Last
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Would you recommend our services to a friend/family? Please give a score on a scale of 0 to 10 (0 = definitely would not recommend, 10 = highly likely to recommend)
What are the 3 major reasons you choose to use us and not another health provider?
1. 2. 3.
If you could improve 3 things about us, what would they be, and how would you change them?
1. 2. 3.
Did you feel that the physiotherapist managed to address the problem?
Strongly disagree Disagree Neutral Agree Strongly agree
Did your physiotherapist communicate clearly and had discussed the assessment findings, diagnosis and treatment plan with you?
Strongly disagree Disagree Neutral Agree Strongly agree
Was the treatment area clean and tidy?
Strongly disagree Disagree Neutral Agree Strongly agree
Did the reception staff make you feel welcome and were helpful with assisting you?
Strongly disagree Disagree Neutral Agree Strongly agree
Is there something that annoys you about dealing with other health providers? And if the answer is Yes please explain what it is.
What is your main concern when choosing a health practitioner?
Could you please give a comment about the standard of services you received during your last visit or visits in the past.
Do you give your permission for us to use your comment above together with your first name only for promotional use (please select Yes or No answer below).
Are there any other services or programmes that you would like us to offer?
What was the name of your treating physiotherapist?
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