Healthcare Feedback Accuracy Survey Form
Please provide your feedback on the accuracy, clarity, and usefulness of the healthcare information or service you received.
How would you rate the overall accuracy of the information or service you received?
*
1
2
3
4
5
How would you rate the overall clarity of the information or service you received?
*
1
2
3
4
5
How useful did you find the information or service provided?
*
1
2
3
4
5
Please indicate your level of agreement with the following statements:
*
Rows
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
The information or service was easy to understand.
1
2
3
4
5
The information or service was up-to-date.
6
7
8
9
10
I felt confident in the accuracy of the information or service.
11
12
13
14
15
The information or service addressed my needs.
16
17
18
19
20
The information or service was delivered in a timely manner.
21
22
23
24
25
What did you like most about the information or service you received?
Do you have any suggestions for improving the accuracy, clarity, or usefulness of the information or service?
Submit Feedback
Should be Empty: