Feedback Form

Thank you for being part of our practice. So that we may better serve you in future appointments, we ask that you take a few minutes to fill out this survey, which is 100% confidential and anonymous.

Please respond to the following statements


When I call reception, I am treated courteously

Strongly Disagree  1 2 3 4 5 Strongly Agree


My emails are answered promptly
Strongly Disagree Strongly Agree


I am able to schedule my appointments at convenient times
Strongly Disagree  1 2 3 4 5 Strongly Agree


When I arrive at my appointments I am greeted warmly
Strongly Disagree  1 2 3 4 5 Strongly Agree


I find the waiting room comfortable and welcoming
Strongly Disagree  1 2 3 4 5 Strongly Agree


I am seen promptly after I arrive
Strongly Disagree  1 2 3 4 5 Strongly Agree


I have confidence in the cleanliness of the practice
Strongly Disagree  1 2 3 4 5 Strongly Agree


I feel the fees for my consultation are reasonable
Strongly Disagree  1 2 3 4 5 Strongly Agree


I feel my needs and concerns are heard
Strongly Disagree  1 2 3 4 5 Strongly Agree


I received a follow-up call/email/SMS after my first appointment


I received a treatment plan or outline
 Yes No


I understood my treatment plan (injury, time of healing, treatment)
Strongly Disagree  1 2 3 4 5 Strongly Agree


I would recommend Penergy Physiotherapy to my friends
Strongly Disagree  1 2 3 4 5 Strongly Agree


What is the main reason you come to this practice


Name (optional)

Email (optional)

Additional comment / testimonial

We really appreciate your feedback. Thankyou from us at Penergy Physiotherapy.