QuestionPunkQuestionPunk
무료로 시작하기
모든 템플릿
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.

이 템플릿 사용하기템플릿 더 둘러보기

샘플 질문

템플릿에 포함된 내용을 미리 확인해 보세요. 모든 질문은 설문 공개 전에 자유롭게 수정할 수 있습니다.

질문 13개 · 약 7분
Q01
메시지

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
객관식필수

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
매트릭스필수

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

5개 행 × 5개 열
  • 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
열: Poor · Fair · Good · Very Good · Excellent
Q04
의견 척도필수

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

척도: 1 – 5
최소:Not at all clearly최대:Extremely clearly
Q05
평점 척도필수

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

범위: 1 – 5
최소:No improvement최대:Fully recovered function
Q06
객관식

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
의견 척도필수

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

척도: 0 – 10
최소:Not at all likely최대:Extremely likely
Q08
AI 인터뷰

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
객관식

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
객관식

What is your age range?

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

What is your gender?

  • Woman
  • Man
  • Non-binary
  • Prefer to self-describe
  • Prefer not to say
Q12
드롭다운

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
메시지

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.

포함된 기능

  • AI 후속 질문

    정형화된 설문이 놓치는 세부 내용을, 주관식 답변에 맞춰 AI가 심층 질문으로 끌어냅니다.

  • 주의력 확인 장치

    성의 없는 답변과 저품질 응답자를 걸러내는 내장 안전장치입니다.

  • AI가 작성한 문안

    문구, 질문 순서, 분기 로직까지 AI가 연구 목표에 맞춰 작성합니다.

  • 자동 리포트

    응답이 모이면 주요 주제, 인용문, 이해하기 쉬운 요약이 자동으로 작성됩니다.

다른 서비스와 비교

다른 설문 도구의 가장 유사한 템플릿을 검토했습니다. 그 도구들이 잘하는 점과, 이 템플릿이 한발 더 나아가는 지점을 정리했습니다.

이 템플릿을 선택하는 이유

  • 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.

잘하는 점

  • 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

아쉬운 점

  • 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.

잘하는 점

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

아쉬운 점

  • 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.

잘하는 점

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

아쉬운 점

  • 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

설문을 공개할 준비가 되셨나요?

이 템플릿을 편집기에서 열어 보세요. 첫 응답자가 보기 전에 모든 부분을 원하는 대로 바꿀 수 있습니다.

Use this template무료로 시작하기

관련 템플릿

같은 카테고리의 다른 설문을 만나 보세요.

전체 보기
Healthcare & Clinical

Pre-Visit Patient Intake & Symptom Screening Survey

Collects chief complaint, symptom severity, medical history, and current medications before an appointment so clinicians walk in prepared. An AI follow-up interview reconstructs the timeline and context behind the patient's main concern — onset, triggers, and what's already been tried — that a checkbox history alone can't capture.

템플릿 보기
Healthcare & Clinical

개인 건강 상태 및 웰빙 평가

자가 평가 건강, 활력, 수면, 스트레스, 증상 심각도, 기존 질환을 포괄하는 전인적 건강 점검입니다. 사람들이 실제로 어떻게 지내고 있는지 추적하는 병원, 고용주, 웰니스 프로그램을 위한 것입니다. AI 후속 인터뷰가 응답자가 가장 심각하다고 표시한 증상이나 질환을 깊이 파고들어, 다음 방문 전에 그 영향과 이미 시도해 본 것들을 밝혀냅니다.

템플릿 보기
Healthcare & Clinical

Nurse Job Satisfaction & Retention Survey

Measures nurse satisfaction across workload, staffing, pay, management support, and career growth, plus burnout frequency and intent to leave. Built for hospital and health-system nursing leadership; the AI follow-up interview digs into the specific shift, policy, or interaction behind a nurse's lowest-rated aspect instead of settling for a generic complaint.

템플릿 보기
Healthcare & Clinical

Massage Therapy New Client Intake Assessment

A pre-session intake for massage and bodywork clients that captures health history, contraindications, areas of tension, and treatment goals so therapists can plan a safe, effective session. An AI follow-up interview digs into the client's primary concern — onset, triggers, and what's already been tried — so therapists walk in with context instead of a blank form.

템플릿 보기
Healthcare & Clinical

Dental Patient Experience & Satisfaction Survey

Measures how patients experience each stage of a dental visit — booking, wait times, pain management, cost transparency, and trust in the dentist — and what drives their willingness to recommend the practice. Built for dental practices and group practices benchmarking patient experience, with an AI follow-up that uncovers the real story behind low or high recommendation scores, especially around anxiety and trust.

템플릿 보기
Healthcare & Clinical

Contactless Health Screening Experience Survey

Captures how people experience contactless health screening kiosks or apps—ease of use, trust in accuracy, and privacy comfort—for clinics, workplaces, and events. An AI follow-up interview digs into the specific moment trust broke down or friction occurred, beyond a simple satisfaction score.

템플릿 보기