PhysiotherapyAllianceCustomerSatisfactionSurvey1. What is your overall satisfaction level with Physiotherapy Alliance?

Very satisfied Somewhat satisfied

Neither satisfied nor dissatisfied

Somewhat dissatisfied

Very dissatisfied

5 4 3 2 1

2. Were you satisfied that your questions were answered clearly?

Very satisfied Somewhat satisfied

Neither satisfied nor dissatisfied

Somewhat dissatisfied

Very dissatisfied

5 4 3 2 1

3. Were you satisfied that the skill level of our staff met or exceeded your expectations?

Very satisfied Somewhat satisfied

Neither satisfied nor dissatisfied

Somewhat dissatisfied

Very dissatisfied

5 4 3 2 1

4. How satisfied were you with the courtesy of staff?

Very satisfied Somewhat satisfied

Neither satisfied nor dissatisfied

Somewhat dissatisfied

Very dissatisfied

5 4 3 2 1

5. Were you satisfied with staff availability?

Very satisfied Somewhat satisfied

Neither satisfied nor dissatisfied

Somewhat dissatisfied

Very dissatisfied

5 4 3 2 1

6. How satisfied were you with the professionalism of staff at Physiotherapy Alliance?

Very satisfied Somewhat satisfied

Neither satisfied nor dissatisfied

Somewhat dissatisfied

Very dissatisfied

5 4 3 2 1

7. How satisfied were you with inter-staff communication regarding your treatment?

Very satisfied Somewhat satisfied

Neither satisfied nor dissatisfied

Somewhat dissatisfied

Very dissatisfied

5 4 3 2 1

8. Would you return for further treatment at Physiotherapy Alliance?

Yes Maybe No

9. Would you recommend Physiotherapy Alliance to family and friends?

Yes Maybe No

10. Do you have any suggestions to improve your overall experience with us?

11. Would you like to be contacted by a representative of Physiotherapy Alliance to discuss your comments further?

Yes (please provide preferred contact information below) No Name: Phone number: Email: