1) Why did you decide to book an appointment with the Little Hiccups Physiotherapist? Had you seen a physiotherapist before?

2) Do you feel the physiotherapist addressed the problem you had identified?

YesNoSomewhat

Any comments?

3) Did you find the physiotherapist communicated well with you and with your child?

YesNoSomewhat

Any comments?

4) Do feel your child worked well with the physiotherapist?

YesNoSomewhat

Any comments?

5) Do you feel the physiotherapist answered your questions?

YesNoSomewhat

Any comments?

6) Was the email advice/exercise programme helpful and clear?

YesNoSomewhat

Any comments?

7) On a scale of 1-5 how satisfied are you to with the physiotherapy appointment?
1 = Very Unsatisfied 5 = Extremely Satisfied.

1 = Very Unsatisfied2 = Unsatisfied3 = Neither Unsatisfied or Satisfied4 = Satisfied5 = Extremely Satisfied

Any comments?

8) How could we improve the service that we offer? For example, session, booking process, staff, feedback?

9) If we could attract further funding for additional sessions would you be interested in attending or recommending to others?

YesNo

Any comments?

Any other comments?

Specific information about children

Is your child aged between 0-4?Is your child aged between 5-9?Is your child aged between 10-16?

Would you be happy for some of the feedback you have provided to be used anonymously as a testimonial on our website and/or social media?

YesNo

This is an anonymous form but if you are happy to be contacted about this or used as a Case Study, please leave your contact details below.

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