exeter physio

Exeter Physio Feedback Form

At Exeter physio we are passionate to deliver the quality of service that you deserve. For that reason we would really value your time to complete this short questionnaire.

We will take on board your comments and use them the best way we can to improve our service.

As a mark of thanks we will take your details into a monthly draw for a half price massage therapy treatment and if successful will inform you by email.

FIRST IMPRESSIONS OF OUR CLINIC
	Worse Better
Your first contact/greeting	1 2 3 4 5 6 7 8 9 10
Information given before arrival (directions etc)	1 2 3 4 5 6 7 8 9 10
Availability of appointments	1 2 3 4 5 6 7 8 9 10
Convenience of appointment time	1 2 3 4 5 6 7 8 9 10
Convenience of clinic location	1 2 3 4 5 6 7 8 9 10
Overall impression of clinic( before visit)	1 2 3 4 5 6 7 8 9 10
ON ARRIVAL
	Worse Better
Ease of finding us / clinic signage	1 2 3 4 5 6 7 8 9 10
Greeting on arrival	1 2 3 4 5 6 7 8 9 10
Promptness of attention	1 2 3 4 5 6 7 8 9 10
Waiting room decor	1 2 3 4 5 6 7 8 9 10
Waiting room comfort	1 2 3 4 5 6 7 8 9 10
Overall first impression of clinic	1 2 3 4 5 6 7 8 9 10
Were you seen for your appointment...	Early On-time 5 mins late 10 mins late 15 mins late 15 mins late +
If delayed over 15 min were you given an explanation for the delay?	Yes No
AVAILABILITY OF AMENITIES
	Worse Better
Facilities for children	1 2 3 4 5 6 7 8 9 10
Papers/magazines	1 2 3 4 5 6 7 8 9 10
Toilet facilities	1 2 3 4 5 6 7 8 9 10
Disabled facilities	1 2 3 4 5 6 7 8 9 10
Overall impression of amenities	1 2 3 4 5 6 7 8 9 10
YOUR APPOINTMENT
	Worse Better
Standard of treatment rooms	1 2 3 4 5 6 7 8 9 10
Level of privacy while dressing/undressing	1 2 3 4 5 6 7 8 9 10
Explanation of procedure and next steps in treatment	1 2 3 4 5 6 7 8 9 10
Take home patient information/advice leaflets	1 2 3 4 5 6 7 8 9 10
Courtesy & consideration of your clinician	1 2 3 4 5 6 7 8 9 10
The level of confidence instilled by your clinician	1 2 3 4 5 6 7 8 9 10
Overall impression of your care	1 2 3 4 5 6 7 8 9 10
RECEPTION / ADMINISTRATION
	Worse Better
General greeting and friendliness	1 2 3 4 5 6 7 8 9 10
Assistance with queries	1 2 3 4 5 6 7 8 9 10
Ease of booking appointments	1 2 3 4 5 6 7 8 9 10
Staff attentiveness	1 2 3 4 5 6 7 8 9 10
TAKING EVERYTHING INTO ACCOUNT
	Worse Better
Overall rating of quality of care	1 2 3 4 5 6 7 8 9 10
Overall rating of value for money	1 2 3 4 5 6 7 8 9 10
Overall rating of our premises	1 2 3 4 5 6 7 8 9 10
Overall rating of our clinic	1 2 3 4 5 6 7 8 9 10
If you have visited us before do you think we are:	1 2 3 4 5 6 7 8 9 10
Would you recommend us?	Yes No
If you have visited a clinic similar to ours, how would you rate our clinic in comparison?	1 2 3 4 5 6 7 8 9 10
COMMENTS & SUGGESTIONS
Please feel free to let us know your thoughts below. (Maximum characters: 350) You have characters left.
YOUR DETAILS
First Name *
Last Name *
Date of Birth
E-mail *