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  1. Home
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  4. Physiotherapy Assessment Form
Patient Feedback

Physiotherapy Assessment Form 2026

This physiotherapy assessment form opens by asking patients to rate three core aspects of their visit — overall experience, therapist professionalism and expertise, and facility cleanliness and comfort — giving the clinic a clear picture of where each part of the patient journey stands. It then asks whether the treatment felt effective and whether the patient would recommend the service, turning subjective impressions into concrete outcome and loyalty signals. A final optional open-ended question invites suggestions, letting patients flag anything the rating scales couldn't capture. After submitting, patients see a short thank-you message confirming their feedback has been received and appreciated.

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This template is ideal for

Physiotherapy clinics

Relies on all three rating questions plus the treatment effectiveness question to monitor care quality across every patient visit.

Rehabilitation centres

Uses the "Do you feel your physical therapy treatment was effective in addressing your condition?" question to track recovery outcomes across a varied patient caseload.

Sports medicine practices

Leans on the "Would you recommend our physical therapy services to others?" question to gauge patient confidence and word-of-mouth potential in a competitive referral market.

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