Medical Treatment Patient Feedback Survey Form
We value your feedback about your recent medical treatment experience. Please complete this survey to help us improve our care.
Overall, how satisfied were you with your recent medical treatment?
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1
2
3
4
5
How would you rate the professionalism of the medical staff?
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1
2
3
4
5
How clearly did the staff explain your treatment and next steps?
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Not clear at all
1
2
3
4
Extremely clear
5
1 is Not clear at all, 5 is Extremely clear
How comfortable did you feel during your visit?
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Not comfortable
1
2
3
4
Very comfortable
5
1 is Not comfortable, 5 is Very comfortable
How would you rate the cleanliness of the facility?
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1
2
3
4
5
How easy was it to schedule your appointment?
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Very difficult
1
2
3
4
Very easy
5
1 is Very difficult, 5 is Very easy
How likely are you to recommend our services to others?
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Not likely
1
2
3
4
Extremely likely
5
1 is Not likely, 5 is Extremely likely
Did you feel your questions and concerns were addressed?
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Yes
Somewhat
No
How would you describe your overall outcome following treatment?
*
Very positive
Somewhat positive
Neutral
Somewhat negative
Very negative
Please share any additional comments or suggestions.
Submit Feedback
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