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Patient Feedback Form
Thank you for taking the time to provide feedback. Your input helps us improve our services and ensures we meet your needs effectively.
Please enable JavaScript in your browser to complete this form.
1. Name (Optional)
2. Date of Last Appointment:
3. Treatment Type
Massage (Hands-On Therapy)
Rehab Session (Exercise Based)
Online Session
Programming Services
Other
4. How did you hear about us?
Referral (Family or Friend)
Online Search
Social Media
Health Insurance
GP
Other
5. How satisfied were you with the overall quality of your session?
Very Satisfied
Satisfied
Neutral
Dissatisfied
Very Dissatisfied
6. Was the treatment effective in addressing your concerns?
No
Not Yet, But I See Progress
On going Maintenance
Partially
Yes
7. How would you rate your therapist’s communication and explanations?
Excellcent
Good
Fair
Poor
8. Was it convenient to book your appointment?
Yes
Somewhat
No
9. How would you rate the flexibility of scheduling options provided?
Excellcent
Good
Fair
Poor
10. How comfortable did you feel during your treatment session?
Very Comfortable
Comfortable
Neutral
Uncomfortable
Very Uncomfortable
11. Was the session tailored to your individual needs?
Yes
Somewhat
No
12. How satisfied were you with the follow-up or aftercare advice provided?
Very Satisfied
Satisfied
Neutral
Dissatisfied
Very Dissatisfied
13. What did you like most about your experience?
14. What could we improve or do differently?
15. Were there any services or support you felt were missing? If so, please specify.
16. Would you recommend our services to others? Why or why not?
17. Are there any services you would like us to add to our business?
Group exercise classes (e.g., mobility or injury prevention)
Virtual group sessions or workshops
Prehabilitation programs (preventative care before surgery or major activity)
Home exercise program design with regular check-ins
Nutritional guidance or support for recovery
Other
If other please state below what other services you would like to see.
session so, you
18. What motivates you to continue physiotherapy (e.g., pain relief, fitness goals, injury prevention)?
19. Would you be interested in additional services, such as online resources, workshops, or exercise guides?
Yes
No
Maybe
20. How frequently would you prefer check-ins or follow-up sessions?
Weekly
Bi-Weekly
Monthly
As Needed
21. If you'd like to share a testimonial, please write it below:
22. Is there anything else you’d like to share about your experience?
Submit
Thank you for your feedback! If you'd like to discuss anything further, feel free to contact us directly.
