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WorkAbility Rehab
Customer Feedback Form
1.
Which of these best describes your involvement with this case
Injured Person
Employer
Treating Medical Practitioner
Scheme Agent / Insurer
Broker
Allied Health Professional
Other (please specify)
2.
Which of the following schemes is relevant to this case
Workers Compensation
Compulsory Third Party (CTP)
Life Insurance
Employer Direct Programs
NDIS
Other (Please specify below)
Other (please specify)
3.
How would you best describe your overall opinion in dealing with WorkAbility Rehab
Exceeded expectations
Met expectations
Below expectations
Additional Comments
4.
How would you rate the level of communication you received from WorkAbility Rehab throughout your involvement?
Far above average
Above average
Average
Below average
Far below average
Additional Comments
5.
Were your queries and requests promptly addressed by WorkAbility Rehab staff members
Strongly agree
Agree
Neither agree nor disagree
Disagree
Strongly disagree
Additional Comments
6.
Please rate the overall performance of the Rehabilitation Consultant in managing your claim
Poor
1 star
Average
2 stars
Good
3 stars
Very Good
4 stars
Excellent
5 stars
Additional Comments
7.
WorkAbility Rehab understood my needs and ensured those needs were addressed at all times
Strongly Disagree
1 star
Disagree
2 stars
Indifferent
3 stars
Agree
4 stars
Strongly agree
5 stars
Additional Comments
*
8.
On a scale of 0 to 10,
How likely is it that you would recommend WorkAbility Rehab to a friend or colleague?
0 for Not at all likely, 10 for Extremely likely
(Required.)
Not at all likely
Extremely likely
0
1
2
3
4
5
6
7
8
9
10
9.
What changes would WorkAbility Rehab have to make for you to give it an even higher rating?
10.
WorkAbility Rehab values your feedback and we would welcome the opportunity to chat to you in more detail about your feedback. If you are happy to receive contact from WorkAbility Rehab, please leave your details below.
Name
Company
City/Town
State/Province
Email Address
Phone Number
Current Progress,
0 of 10 answered