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Patient Satisfaction Survey
Patient Satisfaction Survey
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-- Section One --
As a result of your experience, how likely are you to recommended PHYSIOSOUTH to your friends or colleagues?
1: Not Likely
2
3
4
5: Possibly
6
7
8
9
10: Definitely
As a result of your experience, how likely are you to recommended PHYSIOSOUTH to your friends or colleagues? 1: Not Likely
As a result of your experience, how likely are you to recommended PHYSIOSOUTH to your friends or colleagues? 2
As a result of your experience, how likely are you to recommended PHYSIOSOUTH to your friends or colleagues? 3
As a result of your experience, how likely are you to recommended PHYSIOSOUTH to your friends or colleagues? 4
As a result of your experience, how likely are you to recommended PHYSIOSOUTH to your friends or colleagues? 5: Possibly
As a result of your experience, how likely are you to recommended PHYSIOSOUTH to your friends or colleagues? 6
As a result of your experience, how likely are you to recommended PHYSIOSOUTH to your friends or colleagues? 7
As a result of your experience, how likely are you to recommended PHYSIOSOUTH to your friends or colleagues? 8
As a result of your experience, how likely are you to recommended PHYSIOSOUTH to your friends or colleagues? 9
As a result of your experience, how likely are you to recommended PHYSIOSOUTH to your friends or colleagues? 10: Definitely
How do the following statements reflect on your experience at PHYSIOSOUTH:
-- Section Two --
The waiting area felt welcoming:
Strongly Disagree
Disagree
Neither Agree or Disagree
Agree
Strongly Agree
The waiting area felt welcoming: Strongly Disagree
The waiting area felt welcoming: Disagree
The waiting area felt welcoming: Neither Agree or Disagree
The waiting area felt welcoming: Agree
The waiting area felt welcoming: Strongly Agree
Reception staff dealt with your appointment efficiently:
Strongly Disagree
Disagree
Neither Agree or Disagree
Agree
Strongly Agree
Reception staff dealt with your appointment efficiently: Strongly Disagree
Reception staff dealt with your appointment efficiently: Disagree
Reception staff dealt with your appointment efficiently: Neither Agree or Disagree
Reception staff dealt with your appointment efficiently: Agree
Reception staff dealt with your appointment efficiently: Strongly Agree
All areas of the clinic appeared clean, hygienic and in good state of repair:
Strongly Disagree
Disagree
Neither Agree or Disagree
Agree
Strongly Agree
All areas of the clinic appeared clean, hygienic and in good state of repair: Strongly Disagree
All areas of the clinic appeared clean, hygienic and in good state of repair: Disagree
All areas of the clinic appeared clean, hygienic and in good state of repair: Neither Agree or Disagree
All areas of the clinic appeared clean, hygienic and in good state of repair: Agree
All areas of the clinic appeared clean, hygienic and in good state of repair: Strongly Agree
-- Section Three --
Making you feel at ease:
Poor
Fair
Good
Very Good
Excellent
N/A
Making you feel at ease: Poor
Making you feel at ease: Fair
Making you feel at ease: Good
Making you feel at ease: Very Good
Making you feel at ease: Excellent
Making you feel at ease: N/A
(being friendly and warm towards you, treating you with respect; not cold or abrupt)
Letting you tell your "story":
Poor
Fair
Good
Very Good
Excellent
N/A
Letting you tell your "story": Poor
Letting you tell your "story": Fair
Letting you tell your "story": Good
Letting you tell your "story": Very Good
Letting you tell your "story": Excellent
Letting you tell your "story": N/A
(giving the time to fully describe your injury in your own words; not interrupting or disturbing you)
Being interested in you as a whole person:
Poor
Fair
Good
Very Good
Excellent
N/A
Being interested in you as a whole person: Poor
Being interested in you as a whole person: Fair
Being interested in you as a whole person: Good
Being interested in you as a whole person: Very Good
Being interested in you as a whole person: Excellent
Being interested in you as a whole person: N/A
(asking/knowing relevant details about your life, your situation, not treating you as just a number)
Fully understanding your concerns:
Poor
Fair
Good
Very Good
Excellent
N/A
Fully understanding your concerns: Poor
Fully understanding your concerns: Fair
Fully understanding your concerns: Good
Fully understanding your concerns: Very Good
Fully understanding your concerns: Excellent
Fully understanding your concerns: N/A
(communicating that he/she accurately understood your concerns; not overlooking or dismissing anything)
Showing care and compassion:
Poor
Fair
Good
Very Good
Excellent
N/A
Showing care and compassion: Poor
Showing care and compassion: Fair
Showing care and compassion: Good
Showing care and compassion: Very Good
Showing care and compassion: Excellent
Showing care and compassion: N/A
(seemingly genuinely concerned, connecting with you on a human level; not being indifferent or detached)
Being positive:
Poor
Fair
Good
Very Good
Excellent
N/A
Being positive: Poor
Being positive: Fair
Being positive: Good
Being positive: Very Good
Being positive: Excellent
Being positive: N/A
(having a positive approach and a positive attitude; being honest but not negative about your problem)
Explaining things clearly:
Poor
Fair
Good
Very Good
Excellent
N/A
Explaining things clearly: Poor
Explaining things clearly: Fair
Explaining things clearly: Good
Explaining things clearly: Very Good
Explaining things clearly: Excellent
Explaining things clearly: N/A
(fully answering your questions, giving adequate information; not being vague)
Helping you to take control:
Poor
Fair
Good
Very Good
Excellent
N/A
Helping you to take control: Poor
Helping you to take control: Fair
Helping you to take control: Good
Helping you to take control: Very Good
Helping you to take control: Excellent
Helping you to take control: N/A
(exploring with you what you can do to improve your health yourself; Encouraging rather than “lecturing’ you)
Making a plan of action with you:
Poor
Fair
Good
Very Good
Excellent
N/A
Making a plan of action with you: Poor
Making a plan of action with you: Fair
Making a plan of action with you: Good
Making a plan of action with you: Very Good
Making a plan of action with you: Excellent
Making a plan of action with you: N/A
(discussing the options, involving you in decisions as much as you want to be involved; not ignoring your views)
-- Section Four --
Clinic Visited:
Physiosouth Colombo
Physiosouth Pioneer
Physiosouth Cityfitness Moorhouse
Physiosouth Moorhouse Medical
Physiosouth Cityfitness Northwood
Physiosouth Riccarton
Physiosouth Linwood
Physiosouth Kaiapoi
Physiosouth Pegasus
Physiosouth Waikari
Please feel free to write any comments about your experience at PHYSIOSOUTH here:
Thank you for taking the time to fill in the survey, if you are interested in going into the draw for 1 of 3 $50 MacPac vouchers, please leave your email address:
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