Client Feedback Form – Eatons Hill

You are here:

Thank you for visiting our clinic today. Your feedback is important to us. Please take a minute to answer the questions below.

Your Name
1. What Service did you book in for?*
2. How would you rate the skills of your practitioner?*
- Above Expectations
- Meets Expectations
- Below Expectations
3. Did your therapist listen to your concerns and give you input into your care?*
- Yes
- No
If no, please explain...
4. Do you understand your condition better as a result of your therapy?*
- Yes
- No
Any additional feedback, questions or concerns?
5. Were specific treatments and procedures adequately explained?*
If no, please explain...
6. Do you feel your ongoing exercise/self management program is manageable?*
7. Would you recommend North West Physiotherapy Eatons Hill?
- Yes
- No
- Unsure
8. How could we improve our service?
9. Any additional feedback, questions or concerns?

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