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 12345 Strongly Agree


    My emails are answered promptly
    Strongly Disagree Strongly Agree


    I am able to schedule my appointments at convenient times
    Strongly Disagree 12345 Strongly Agree


    When I arrive at my appointments I am greeted warmly
    Strongly Disagree 12345 Strongly Agree


    I find the waiting room comfortable and welcoming
    Strongly Disagree 12345 Strongly Agree


    I am seen promptly after I arrive
    Strongly Disagree 12345 Strongly Agree


    I have confidence in the cleanliness of the practice
    Strongly Disagree 12345 Strongly Agree


    I feel the fees for my consultation are reasonable
    Strongly Disagree 12345 Strongly Agree


    I feel my needs and concerns are heard
    Strongly Disagree 12345 Strongly Agree


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


    I received a treatment plan or outline
    YesNo


    I understood my treatment plan (injury, time of healing, treatment)
    Strongly Disagree 12345 Strongly Agree


    I would recommend Penergy Physiotherapy to my friends
    Strongly Disagree 12345 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.