Physiotherapy/Acupuncture Clinic Questionnaire

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Information

You have recently attended the Physiotherapy Clinic and received Physiotherapy treatment.

We aim to work to the highest professional standards; to help us deliver this level of care, we would be grateful if you would complete the following questionnaire.

All completed questionnaires will be treated confidentially.

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Appointment Experience

Please rate your response to each statement based on the following scale:

1=Poor 2=Fair 3=Good 4=Very Good/Excellent

Interval between seeing your GP and seeing the physiotherapist:

Satisfaction with day and time of your physiotherapy appointment:

The physiotherapist treated you with courtesy and respect:

The physiotherapist explained the nature of your planned treatment:

Felt able to ask questions and discuss treatment freely with the physiotherapist:

Felt the physiotherapist had sufficient time to understand and manage the condition:

Upon discharge felt confident to continue/progress your treatment plan:

Overall satisfaction with the physiotherapy service:

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Additional Questions

How did you travel to your appointment?:

Was local access to the surgery satisfactory?:

Privacy Consent

This form collects personal and medical information about you. We use this information to allow the practice team to contact you. Please read our Privacy Policy to discover how we protect and manage your submitted data.

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Physiotherapy/Acupuncture Clinic Questionnaire

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NORTHGATE MEDICAL PRACTICE

BLEAN BRANCH SURGERY

CHARTHAM SURGERY

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