Medway Medical Center Physiotherapy Feedback

Form
Room no: Date:

 Physiotherapy Treatment goals were explained?

1 2 3 4 5

 Physiotherapist was knowledgeable about my condition?

1 2 3 4 5

 Physiotherapist was courteous and professional?

1 2 3 4 5

 Physiotherapist was helpful during my treatment?

1 2 3 4 5

 Physiotherapist took the time to answer my questions?

1 2 3 4 5

 Overall I am satisfied with the treatment I have received?

1 2 3 4 5

 Would you recommend us to a friend or family member?

Yes No

Your feedback on words:

Would you like to give credit for any of our physiotherapist?

Details of patient’s attender/patient with mobile no and email id: