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Patient feedback survey template

A short, private survey about care, communication and booking, to learn what to keep and what to fix.

How to use it: Habits of Physiotherapists Who Never Run Out of Patients

Your experience

  1. Overall, how was your care? (0–10) Scale 0 to 10
  2. How well did we explain your problem and plan? (0–10) Scale 0 to 10
  3. How easy was it to book and attend? (0–10) Scale 0 to 10
  4. What did we do well? Written answer
  5. What could we do better? Written answer
  6. You may contact me about my feedback Tick box

A starting point, not clinical advice. Check that it fits your patients, your practice and the rules where you work before you use it.