This printable physical therapy patient satisfaction survey helps clinics and rehabilitation practices collect honest feedback from every patient across 12 questions on two pages. It captures how well therapists communicate, whether pain and mobility are improving, and how comfortable each session felt.
What this survey measures
The questions cover the full physiotherapy experience. An agreement grid asks patients whether their therapist explained their condition clearly, listened to their concerns, demonstrated the exercises well, agreed goals with them, and treated them with respect. A progress section tracks changes in pain and daily function and how confident patients feel with their home exercises, and a second grid rates booking, punctuality, reception, cleanliness, equipment, and billing. An overall care rating and a recommendation score give you numbers to track over time, and an open comment box captures anything the fixed questions miss.
How to use it on paper
Hand the survey to patients at checkout or leave copies in the waiting room with a drop box at the front desk. Patients fill the checkboxes with a blue or black pen. Collect the completed forms and scan them in batches. PaperSurvey reads the checkbox answers with optical mark recognition and converts the handwritten comments to text automatically, so results appear in your dashboard without any manual data entry.
Customize this template
Add your clinic logo, reword the statements to match your specialty, or add questions about specific treatments and staff. Add or remove questions as needed, and the paper layout reflows automatically as you edit so every copy you print stays scannable.
Preview the PDF above, or use this template to start collecting physical therapy feedback today.