Fertility Clinic Mystery Shopper Form
Fertility Clinic Mystery Shopper Form: Please provide your assessment of your recent fertility clinic visit. Your feedback helps us evaluate and improve service quality.
Date of Visit
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Purpose of Visit
*
Please Select
Consultation
Follow-up
Lab Test
Treatment Discussion
Other
How would you rate the professionalism of the staff?
*
1
2
3
4
5
How would you rate the cleanliness of the clinic?
*
1
2
3
4
5
How would you rate the ease of scheduling your appointment?
*
1
2
3
4
5
How long did you wait before being attended to?
*
Less than 10 minutes
10-20 minutes
21-30 minutes
More than 30 minutes
Please evaluate the following aspects of your visit:
*
Rows
Excellent
Good
Average
Poor
Reception friendliness
1
2
3
4
Staff knowledge
5
6
7
8
Privacy during visit
9
10
11
12
Clarity of information provided
13
14
15
16
Were all your questions answered satisfactorily?
*
Yes
Partially
No
Would you recommend this clinic to others?
*
Yes
No
Not sure
Additional Comments or Suggestions
Submit Evaluation
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