Patient Satisfaction Survey
Is this your first time in our facility?
Yes
No
How frequently do you visit our facility?
Weekly or more
Monthly
Quarterly
Less than quarterly
Do you have an insurance plan?
Yes
No
How satisfied are you with the booking process?
Not Satisfied
1
2
3
4
5
6
7
8
9
Very Satisfied
10
1 is Not Satisfied, 10 is Very Satisfied
How satisfied are you with check in and welcoming process?
Not Satisfied
1
2
3
4
5
6
7
8
9
Very Satisfied
10
1 is Not Satisfied, 10 is Very Satisfied
Has the doctor passed the appointment schedule?
Yes
No
How long did you need to wait for the appointment? (past the appointment time)
Less than 30 min.
30 min. - 45 min.
45 min. - 60 min.
More than 60 min.
Please rate the followings
Professionalism of staff
1
2
3
4
5
Hygiene in the facility
1
2
3
4
5
Kindness of medical personnel
1
2
3
4
5
Care provided by the doctor
1
2
3
4
5
Co-ordination between departments
1
2
3
4
5
By considering overall experience with our facility, how likely would you recommend to your friends/family?
Not Likely
1
2
3
4
5
6
7
8
9
Very Likely
10
1 is Not Likely, 10 is Very Likely
Please share any comments/suggestions
Submit
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