Feedback Form Name (optional) First Name Last Name Who is your physiotherapist? Anas Angel Christin Danar Else Esti Heru Mutiara Oti Tari How would you rate your physiotherapist overall? * 1 - very poor 2 - below average 3 - average 4 - good 5 - excellent How would you rate your physiotherapist's knowledge with regards to your injury? * 1 - very poor 2 - below average 3 - average 4 - good 5 - excellent How would you rate your treatment and rehabilitation you received? * 1 - very poor 2 - below average 3 - average 4 - good 5 - excellent Is your physiotherapist always on time? * Yes No What are some ways that your physiotherapist could improve? How would you rate our bookings and admin team? * 1 - very poor 2 - below average 3 - average 4 - good 5 - excellent How easy is it to make a booking? * 1 - difficult 2 - okay 3 - easy What are some ways that the admin team could improve? How clean and tidy did you find our clinic? * 1 - very poor 2 - below average 3 - average 4 - good 5 - excellent Would you recommend Akeso to a friend? * 1 - no, I don't think so 2 - maybe 3 - yes, definitely How would you rate Akeso overall? * 1 - very poor 2 - below average 3 - average 4 - good 5 - excellent Comments & Suggestions Complaints, feedback or things you are happy with :) Would you be willing to give a testimonial that we can upload to our social media? * Yes, I'd be happy to give a written testimonial Yes, I'd be happy to give a video testimonial No, thanks Thank you for your feedback!
