Patient Survey Form

We are very interested in getting your thoughts about our service. Any feedback about specific things that we could do to change or improve our service would be appreciated.

Why did you decide to come to PhysioMaxx?

• Doctor
• Yellow Pages
• Drive By
• Website
• Family / Friend
• Other

What were 2 of the biggest concerns you had before you decided to come to PhysioMaxx?

• Price
• Location
• Treatment
• Will it hurt
• Physiotherapist's knowledge
• Other

How would you rate our treatment?

• Excellent
• Good
• Fair
• Poor

How would you rate the services at our Practice?

Treatment Rooms

• Excellent
• Good
• Fair
• Poor

Clinical Pilates

• Excellent
• Good
• Fair
• Poor

Repex Bed

• Excellent
• Good
• Fair
• Poor

Reception

• Excellent
• Good
• Fair
• Poor

Variety of different treatments

• Excellent
• Good
• Fair
• Poor

Other

• Excellent
• Good
• Fair
• Poor

If you were to recommend us to someone else what would you say?

Do you have any special suggestions on how we can improve?

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