PATIENT SATISFACTION SURVEYPlease rate each question by choosing the answer that best describes your opinion
Appointment date *
Phone (if you would like to be contacted)
Email (if you would like to be contacted or receive a confirmation)
How satisfied are you with the appointment availability? *PoorFairGoodVery GoodExcellent
How satisfied are you with the waiting time at the clinic? *PoorFairGoodVery GoodExcellent
How well did the clinic staff (reception, technologists) instruct you on preparations or what to expect during your test? *PoorFairGoodVery GoodExcellent
Willingness of clinic staff to answer your questions? *PoorFairGoodVery GoodExcellent
How clear and complete were the explanations about any possible risks or complications with your test? *PoorFairGoodVery GoodExcellent
Courtesy and respect you were given, friendliness; how well did the staff listen to what you had to say; how well did the staff understand what you thought was important? *PoorFairGoodVery GoodExcellent
How well was your privacy considered, for example, gowns and privacy while changing? *PoorFairGoodVery GoodExcellent
How would you recommend the clinic to a friend or family member if they needed service that it provides?PoorFairGoodVery GoodExcellent
How would you rate this clinic's environment?PoorFairGoodVery GoodExcellent
How would you rate this clinic overall?PoorFairGoodVery GoodExcellent
Comments
Leave empty
