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Patient Experience Feedback Form

This form is designed to capture feedback from your visit to Tyack Health. If you have any questions, feel free to contact us on (07) 3249 5333 or email us at admin@tyackhealth.com.au

Full Name or Anonymous: *

What date was your visit: *

Which area did you see today: *

Medical

Podiatry

Bowen Therapy

Chiropractic

Acupuncutre

Reflexology

Physiotherapy

Dietitian

Exercise Classes

Prof. Massage

Naturopathy

Audiologist

How well did the Phone Staff serve you: *

Excellent

Good

Average

Poor

Very Poor

How well did the Desk Staff serve you: *

Excellent

Good

Average

Poor

Very Poor

How well did the Nurse or Massage Staff serve you:

Excellent

Good

Average

Poor

Very Poor

How well did the Practitioner or Doctor serve you:

Excellent

Good

Average

Poor

Very Poor

Did you find it easy to make an appointment: *

Yes

Did you get an appointment at the time you preferred: *

Yes

Did you get an appointment with your preferred practitioner: *

Yes

Were you kept waiting longer than expected at anytime throughout your visit: *

Yes

If yes, please specify:

Was the practice clean:

Very clean

Average

Unclean

Reading Material:

Excellent

Good

Poor

Cafe Bar:

Enjoyable

Average Poor

Seating:

Too soft

Too hard

Comfortable

Treatment couch:

Too hot

too cold

Just right

Were the aromas:

Pleasant

Acceptable

Unpleasant

Temperature:

Too hot

Too cold

Just right

Music selection:

Too mellow

Too up beat

Just right

Music volume:

Too soft

Too loud

Just right

Were your expectations met during your consultation: *

Exceeded expectations

Met expectations

Did not meet expectations

In what ways could your visit or consultation have been improved: *

What could we do for you that we are not doing now: *

Address: 148 Radford Rd, Manly West Brisbane QLD 4179
Phone: (07) 3249 5333 Fax: (07) 3393 4999