Cardiac and Neurological Care Survey
Please share your experiences and feedback regarding your cardiac and neurological healthcare. Your responses will help us improve our services.
Please provide your full name.
*
First Name
Last Name
Email address for follow-up (optional).
example@example.com
What is your age group?
*
Please Select
Under 18
18-29
30-44
45-59
60 and above
What is your gender?
*
Female
Male
Prefer not to say
Non-binary/Other
Which of the following best describes your recent healthcare experience?
*
Cardiac care (heart-related)
Neurological care (brain/nerves-related)
Both cardiac and neurological care
Please rate the following aspects of your cardiac care experience.
Rows
Excellent
Good
Fair
Poor
Timeliness of care
1
2
3
4
Communication with healthcare providers
5
6
7
8
Clarity of treatment plan
9
10
11
12
Management of symptoms
13
14
15
16
Please rate the following aspects of your neurological care experience.
Rows
Excellent
Good
Fair
Poor
Timeliness of care
17
18
19
20
Communication with healthcare providers
21
22
23
24
Clarity of treatment plan
25
26
27
28
Management of symptoms
29
30
31
32
Have you experienced any of the following symptoms recently? (Select all that apply)
Chest pain or discomfort
Irregular heartbeat
Shortness of breath
Dizziness or fainting
Memory loss or confusion
Numbness or tingling
Seizures
Other
Overall, how satisfied are you with the cardiac and neurological care you received?
*
1
2
3
4
5
Please share any additional comments or suggestions for improving our cardiac and neurological care services.
Submit Survey
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