TELEHEALTH VIA ZOOM FEEDBACK FORM

At Down South Therapy we take great pride in maintaining our reputation for delivering therapy services to the highest of standards.
Thank you for taking the time to offer us feedback regarding your recent Telehealth Session via Zoom.
We value all feedback as this is key to us maintaining and improving our service delivery to our West Australian community. Once we have received your feedback, we will respond within five working days and keep you informed of progress.

Please complete the electronic form below:

URL
This field is for validation purposes and should be left unchanged.
Your feedback is important to us
Please indicate the business area(s) your feedback relates to:
- Occupational Therapy
- Speech Pathology
- Physiotherapy
- Psychology
Name of Therapist/s
Your contact details
Full name*
First Name Last Name
Phone*
Email
Date of most recent session
Please indicate preferred contact method:
- Phone
- Email
- Mail
Your feedback
Please provide your feedback below.

Please indicate on a scale of 1-5 how satisfied you were with the overall experience using Zoom.
1 - Well below expectations
2 - Below expectations
3 - Met expectations
4 - Above expectations
5 - Well above expectations
Video Quality
Audio Quality
Participant's enjoyment of the session
Participant's engagement in the session
Therapist's overall competency in delivery of session
Is there anything that you would like to see change for future therapy sessions?
Further feedback on session (level of engagement, feeling comfortable etc.).
Please check this box if you DO NOT wish for this feedback to be shared across our media platforms.
Please note, We will only use the names of therapist's, not the names of the participant's or those providing feedback.
- I do not wish for this feedback to be shared with the public.

TELEHEALTH VIA ZOOM FEEDBACK FORM

Your feedback is important to us

Your contact details

Your feedback

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