OH Therapy team feedback form

60 second feedback: Occupational Health Therapies

Your feedback is vital to maintaining a quality Occupational Health service. Please answer this quick survey in regards to your experience with the Physiotherapist or Occupational Therapist. We thank you for taking the time to complete this feedback.

Question Title

* 1. Please select area of musculoskeletal complaint that best describes your reason for referral (if there are more then one select multiple)

Lower back

Mid back, chest

Neck, head

Arms (should, elbow, wrist, hands)

Legs (hips, knees, ankles, feet)

Question Title

* 2. What long term management strategies have you been provided in order to manage your condition? (select more than one if required)

Exercises

Lifestyle advice

Workstation adjustments and advice

Task adaptation in the workplace

Condition Management

Other (please specify)

Question Title

* 3. Please select your work status at time of referral

At work on Full Duties

At Work on Restrictions

Off work

Temporary Redeployment

Permanent Redeployment

Medical Retirement

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* 4. Please select your work status at time of discharge

At work on full duties

At work on restrictions

Off work

Temporary redeployment

Permanent redeployment

Medical Retirement

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* 5.
How likely is it that you would recommend the therapy teams' services in Occupational Health to your colleagues?

Very likely

Likely

Neither likely nor unlikely

Unlikely

Very unlikely

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* 6. Please select how you were referred into the therapies team at Occupational Health

Self Referral

Management Referral

Question Title

* 1. Please select area of musculoskeletal complaint that best describes your reason for referral (if there are more then one select multiple)

Question Title

* 2. What long term management strategies have you been provided in order to manage your condition? (select more than one if required)

Question Title

* 3. Please select your work status at time of referral

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* 4. Please select your work status at time of discharge

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* 5. How likely is it that you would recommend the therapy teams' services in Occupational Health to your colleagues?

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* 6. Please select how you were referred into the therapies team at Occupational Health

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* 7. Please enter any further comments you would like to make

* 5.
How likely is it that you would recommend the therapy teams' services in Occupational Health to your colleagues?