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Feed Back Form Updatedd

The document is a patient feedback form for IPC, aimed at gathering feedback to improve services. It includes questions about overall experience, quality of care, staff friendliness, treatment explanation, appointment scheduling, clinic cleanliness, and likelihood of recommending the clinic. Patients are also invited to provide additional comments and suggestions.

Uploaded by

shahriyararif01
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4 views1 page

Feed Back Form Updatedd

The document is a patient feedback form for IPC, aimed at gathering feedback to improve services. It includes questions about overall experience, quality of care, staff friendliness, treatment explanation, appointment scheduling, clinic cleanliness, and likelihood of recommending the clinic. Patients are also invited to provide additional comments and suggestions.

Uploaded by

shahriyararif01
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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PATIENT FEEDBACK FORM

Thank you for choosing IPC. We value your feedback and aim to continually improve our services.
Please take a moment to complete this form.
Full Name: __________________________________ Phone Number: ____________________

Email: __________________________________ Date: ____________________

Gender: __________________________________

How would you rate your overall


experience at our clinic? ☐ ☐ ☐ ☐ ☐
1 = Poor, 5 = Excellent) 1 2 3 4 5
How satisfied are you with the quality
of care provided by our ☐ ☐ ☐ ☐ ☐
physiotherapist? Very Unsatisfied Neutral Satisfied Very
Unsatisfied Satisfied
Was the clinic staff friendly and
helpful? ☐ ☐
Yes No
Did you feel your treatment plan was
clearly explained to you? ☐ ☐ ☐
Yes No Somewhat
Were you satisfied with the
appointment scheduling process? ☐ ☐ ☐
Yes No Neutral
How would you rate the cleanliness
and comfort of the clinic? ☐ ☐ ☐ ☐
Poor Fair Good Excellent
How likely are you to recommend our
clinic to family or friends? ☐ ☐ ☐ ☐ ☐
Not Likely Unlikely Neutral Likely Very Likely
Would you be willing to provide video
feedback ☐ ☐
Yes No

Do you have any additional comments, suggestions, or recommendations for improvement?

Thank you for your valuable feedback! It helps us serve you better.

Al Mooed Plaza, Sector D, PWD Housing Society, Islamabad, Pakistan


+92 329 5446120/051 5975074

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