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Healthcare & Clinical

Physical Therapy Patient Experience Evaluation

Measures how patients experience physical therapy care — clarity of communication, pain management during exercises, and real functional progress — built for clinics, rehab practices, and outpatient PT groups. The AI follow-up interview digs past satisfaction scores to reconstruct what actually happened in sessions and why recovery felt fast, slow, or stalled.

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設問の例

テンプレートの内容をプレビューできます。すべての設問は公開前に自由に編集できます。

全13問・約7分
Q01
メッセージ

Thanks for taking a few minutes to reflect on your physical therapy care! Your honest feedback helps your clinic improve treatment for everyone. Your responses are completely confidential and anonymized. This should take about 5 minutes.

Q02
選択式必須

How many physical therapy sessions have you completed as part of your current treatment plan?

  • 1-3 sessions
  • 4-6 sessions
  • 7-10 sessions
  • More than 10 sessions
Q03
マトリクス必須

Thinking about your sessions overall, how would you rate your therapist on each of the following?

5行 × 5列
  • Communicated clearly about your treatment plan
  • Listened to your concerns and pain levels
  • Explained exercises so you could do them correctly on your own
  • Was punctual and used your session time well
  • Adjusted treatment when you reported pain or difficulty
列: Poor · Fair · Good · Very Good · Excellent
Q04
オピニオンスケール必須

How clearly did your therapist explain the goals of your treatment plan?

スケール: 1 – 5
最小:Not at all clearly最大:Extremely clearly
Q05
評価スケール必須

Compared to when you started treatment, how much has your physical function or mobility improved?

範囲: 1 – 5
最小:No improvement最大:Fully recovered function
Q06
選択式

During exercises that caused some discomfort, how well did your therapist manage your pain level?

  • Always managed appropriately
  • Usually managed appropriately
  • Sometimes pushed too hard
  • Often pushed too hard
  • I did not experience discomfort during exercises
Q07
オピニオンスケール必須

How likely are you to recommend this physical therapist to a friend or family member dealing with a similar condition?

スケール: 0 – 10
最小:Not at all likely最大:Extremely likely
Q08
AIインタビュー

Probe the story behind the respondent's recommendation score and their reported functional improvement. Ask them to describe one specific session that stands out — good or bad — and what the therapist did or didn't do. If they gave a low recommendation score or reported little improvement, dig into what specifically stalled progress (pain management, unclear instructions, feeling rushed) and what would have changed the outcome. If they gave a high score, find out which specific behavior from the therapist drove that trust.

Q09
選択式

Which parts of your care, if any, would you like to see improved?

  • Scheduling flexibility
  • Wait times before sessions
  • Clarity of home exercise instructions
  • Amount of one-on-one time with therapist
  • Communication between visits
  • Nothing - I'm satisfied with my care
Q10
選択式

What is your age range?

  • Under 18
  • 18-29
  • 30-44
  • 45-59
  • 60-74
  • 75 or older
  • Prefer not to say
Q11
選択式

What is your gender?

  • Woman
  • Man
  • Non-binary
  • Prefer to self-describe
  • Prefer not to say
Q12
プルダウン

What was the primary reason you sought physical therapy?

  • Post-surgical rehabilitation
  • Sports or musculoskeletal injury
  • Chronic pain management
  • Neurological condition
  • Fall prevention or balance issues
  • Other
  • Prefer not to say
Q13
メッセージ

That's everything — thank you! Your responses will be shared with the clinic's care quality team to recognize what's working and improve what isn't.

含まれる機能

  • AIによる深掘り

    自由回答に合わせてAIが追加で質問し、固定のフォームでは拾えない具体的な内容を引き出します。

  • 注意確認設問

    急いだ回答や質の低い回答者を除外する仕組みを標準で備えています。

  • AIが作成する設問文

    文言、設問の順序、条件分岐をAIが調査の目的に合わせて作成します。

  • 自動レポート

    回答が集まると、テーマ、引用、わかりやすい要約が自動で作成されます。

他ツールとの比較

ほかのアンケートツールで最も近いテンプレートを調べました。それぞれの優れている点と、このテンプレートがさらに踏み込んでいる点をまとめています。

このテンプレートを選ぶ理由

  • Goes beyond a satisfaction score with an AI follow-up interview that probes the story behind a patient's recommendation rating and why recovery felt fast, slow, or stalled
  • Combines structured measurement (matrix rating of therapist behaviors, opinion scales on clarity of goals and likelihood to recommend, a functional-progress rating) with open-ended reconstruction of what actually happened in sessions
  • Directly asks how well pain was managed during uncomfortable exercises, not just overall satisfaction
  • Closes with a transparent note that responses are shared with the clinic's care team, plus demographic and reason-for-care questions for segmentation

Jotform

Physical Therapy Evaluation Form Template

A ready-to-field static form for collecting patient feedback on physical therapy care, built on Jotform's drag-and-drop form builder. It covers standard evaluation fields but relies on fixed questions rather than any adaptive follow-up. Good for quick deployment and easy embedding into clinic intake workflows.

優れている点

  • Fast to deploy and customize via Jotform's builder
  • Widely used, familiar form format for clinics
  • Easy integration with Jotform's broader forms/e-signature ecosystem

物足りない点

  • Static question set with no adaptive AI follow-up to probe why recovery felt fast, slow, or stalled
  • No automated per-response quality scoring
  • No published methodology for how questions map to outcomes

SurveySparrow

Physical Therapy Evaluation Form Template

A conversational-style survey template for physical therapy evaluation, fielding-ready within SurveySparrow's chat-like survey format. It's designed for a friendlier respondent experience but still uses pre-set questions rather than dynamic AI-driven probing. Suited for clinics wanting a simple, mobile-friendly feedback loop.

優れている点

  • Conversational UI that may improve completion rates
  • Fielding-ready template for healthcare feedback
  • Mobile-friendly survey delivery

物足りない点

  • No adaptive AI follow-up interview to dig into the story behind scores
  • No optional voice AI interview option
  • No automated report generation tied to per-response quality scoring

Typeform

Physical Therapist Evaluation Form Template

A polished, fielding-ready one-question-at-a-time form for evaluating physical therapists, built on Typeform's well-known conversational form format. It emphasizes visual design and respondent experience but the question flow is fixed rather than adaptive to individual answers. Works well for basic satisfaction capture rather than deeper diagnostic follow-up.

優れている点

  • Clean, engaging one-question-at-a-time interface
  • Strong design and branding customization
  • Established, fielding-ready template

物足りない点

  • No AI-driven follow-up questioning to reconstruct what happened in sessions
  • No guided task or screen-share capability
  • No transparent, published prompt methodology for how insights are derived

よくあるご質問

「Physical Therapy Patient Experience Evaluation」テンプレートにはどのような設問が含まれていますか？

すぐに使える設問が13問含まれており、最初の設問は次のとおりです：「Thanks for taking a few minutes to reflect on your physical therapy care! Your honest feedback helps your clinic improve…」・「How many physical therapy sessions have you completed as part of your current treatment plan?」・「Thinking about your sessions overall, how would you rate your therapist on each of the following?」。すべての設問は上でプレビューでき、自由に編集できます。

このアンケートの回答にはどのくらい時間がかかりますか？

回答者は通常、13問を約7分で回答し終えます。

テンプレートは編集できますか？

はい。公開前であれば、すべての設問、選択肢、順序を編集できます。設問の追加や削除のほか、調査の目的に合わせた作り直しをAIエディターに依頼することもできます。

このテンプレートは無料で使えますか？

はい。エディターで開けば、すぐに編集を始められます。お試しにアカウントは不要で、無料プランでアンケートを公開できます。

公開の準備はできましたか？

このテンプレートをエディターで開いてみてください。最初の回答者が目にする前に、すべてを自由に変更できます。

このテンプレートを使う無料で始める

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