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Patient info

  • Initial Intake Form
  • Patient In-Take Form
  • Health History Form
  • Patient Feedback Form
Initial Intake Form
patient in-take form
health history form

    Patient Feedback



    • Was this your first visit to Claireviewrehab Physiotherapy?

    • What service(s) have you received? (Please check all that apply)*

    • Receptionist Was Courteous And Professional?

      Treatment goals were explained?

      Therapist/Doctor was knowledgeable about my condition?

      Therapist/Doctor was courteous and professional?

      Therapist/Doctor was helpful during my treatment?

      Therapist/Doctor took the time to answer my questions?

      Overall I Am Satisfied With The Treatment I Have Received?

      Would you recommend us to a friend or family member?

      Do You Believe That You Are Well Informed About Our Services And Products?

    • What would you like to see improved Claireville Physiotherapy?

    • What do you like most about Claireville Physiotherapy?

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