Survey Test

Test form


    1. When did you first attend Restore Physiotherapy?

    Last 3 monthsLast 6 monthsLast 12 months1-5 years ago5 + years ago

    2. When did you last attend Restore Physiotherapy?

    Last 3 monthsLast 6 monthsLast 12 months1-5 years ago5 + years ago

    3. How many times have you attended Restore Physiotherapy ?

    OnceTwice2-10 visits10+ visits

    4. What service do you primarily use at Restore Physiotherapy?

    Physiotherapy onlyClinical Exercise onlyPhysiotherapy and Clinical ExerciseWomen’s and Men’s Health PhysiotherapyAll of the above

    If you attend for Physiotherapy or Women’s and Men’s Health Physiotherapy services, please complete this section.


    1. What motivates you to seek treatment at Restore Physiotherapy (can choose more than one response)?

    2. Are you currently receiving treatment?


    3. If you have stopped treatment. Why? (Can choose more than one response):

    4. Were you able to access an appointment with one of our physiotherapists in a timely manner (time and day that suited)?


    5. What is your preferred times to seek treatment?

    6. How would you rate the quality of your physiotherapy experience under the following categories?

    a. Personable and friendly

    b. Confidence in physiotherapist’s skills

    c. Ability to diagnose and treat your condition

    d. Ability to implement and communicate an appropriate management plan

    e. Resolve your problem

    If you attend for Clinical Exercise, please complete this section.


    1. What motivates or has motivated you to attend Clinical Exercise at Restore Physiotherapy (Can choose more than one response)?

    Manage/recover from injury/condition/surgeryPregnancyPost pregnancyFitness and health benefitsSocialisingOther. (Comment below)

    2. If you are currently still attending Clinical Exercise classes:

    a. How often do you attend?

    b. How long have you been coming?

    3. What are your preferred class times?

    4. How easy is it for you to attend a class at a time suitable for you?

    5. What factors are important to your Clinical Exercise experience (Can choose more than one response)?

    Physiotherapist supervisedCostFriendly staffQuality equipmentQuality studio and spaceMy program is appropriately progressedHelps my problem

    6. Is it important to you that Clinical Exercise sessions are supervised by a physiotherapist?

    7. How much do value your Clinical Exercise reviews?

    8. If you have stopped coming to Clinical Exercise. What was your reason?


    How would you rate our reception staff on the factors below?

    1. Friendly


    2. Professional


    3. Explanation of fees, billing and paperwork


    4. Timely attention to your needs


    5. Overall quality of reception and administration staff




    1. Which of the following (if any) services would you use if they were provided by Restore Physiotherapy (Can choose more than one response)?

    Massage therapy/MyotherapyDietician/NutritionistSports medicine doctorPsychologistRealtime Ultrasound (facilitate pelvic floor/core muscle contraction)Other. (Comment below)

    2. Would you recommend Restore Physiotherapy to family and friends?


    3. If you have any other comments or thoughts regarding Restore Physiotherapy, feel free to make a comment below: