Physiotherapy — quick feedback

Patient feedback for Physiotherapy

About 2 minutes. Your answers help us improve care.

Questions marked * are required.

Who is filling this form? *

Patient (myself)Parent / guardianOther family memberOther

What service did you receive today? *

Overall, how was today’s visit? *

1 — Very poor5 — Excellent

How would you rate reception / registration / payment today? *

1 — Very poor5 — Excellent

Was the waiting time acceptable? *

YesSomewhatNo

Were staff polite and respectful? *

1 — Very poor5 — Excellent

How clean and comfortable was the facility? *

1 — Very poor5 — Excellent

Did the doctor / provider explain clearly? *

Yes, clearlyPartlyNoI did not see a provider

How would you rate the quality of care today? *

1 — Very poor5 — Excellent

How safe and trustworthy did you feel during your visit? *

1 — Very poor5 — Excellent

What is one thing we could improve? (Optional)

What did we do well today? (Optional)

May we contact you about this feedback?

No, keep anonymousYes

Name *

Phone *

Preferred time *

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