Patient Survey Form


Overall, how would you rate your experience of Bodybalance Physiotherapy & Sports Injury Clinic, on a scale of 0 to 10 with 0 being Extremely Unsatisfied and 10 being Extremely Satisfied?
  0 1 2 3 4 5 6 7 8 9 10
Choose one option
How likely would you be to recommend Bodybalance Physiotherapy & Sports Injury Clinic to a friend/colleague, on a scale of 0 to 10 with 0 being Extremely Unlikely and 10 being Extremely Likely?
  0 1 2 3 4 5 6 7 8 9 10
Choose one option
What is the main reason you have given your score for Questions 1 & 2?

How did we do in the following areas of service, on a scale of 0 to 10 with 0 being Extremely Unsatisfied and 10 being Extremely Satisfied?
  0 1 2 3 4 5 6 7 8 9 10
Ease of making an appointment
Appointment Availability
Professionalism
Communication
Clinical Knowledge
Accurate Diagnosis
Quality of Treatment
Sports Expertise
Follow up service provided after discharge
Value for money
Clinic rooms and facilities
To what extent do you agree with the following statements on a scale of 0 to 10 with 0 being Extremely Disagree and 10 being Extremely Agree?
  0 1 2 3 4 5 6 7 8 9 10
My treatment plan was explained to me in a way that I understood.
The clinician listened to my needs and objectives.
I have now either recovered completely or have recovered to the level which I expected I would.
The time it took for my recovery was as I expected.
My overall experience at Bodybalance met, or exceeded, my initial expectations.
Please tell us any areas you think we can improve on.

Who was your main treating clinician?

Please add any further comments you would like to make:

To be entered into our monthly prize draw for your choice of either a FREE 1 hour Sports Massage at our Hertfordshire clinic, or a FREE Guest Pass to Laboratory Spa & Health Club – Mill Hill, please add your name and email in the box below. Winners will be notified by email and announced on our Facebook page. One winner will be announced each month.
 
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