Healthcare Facility Service Quality Survey Form
We value your feedback. Please share your experience to help us improve our services.
What was the main reason for your visit?
*
Which department or service did you visit?
*
Please Select
General Practice
Emergency
Pediatrics
Outpatient Clinic
Laboratory
Radiology/Imaging
Pharmacy
Other
How would you rate the courtesy and professionalism of the staff?
*
1
2
3
4
5
How clearly did the staff communicate with you?
*
Not clear
1
2
3
4
Very clear
5
1 is Not clear, 5 is Very clear
How would you rate the wait time for your appointment or service?
*
Very long
1
2
3
4
Very short
5
1 is Very long, 5 is Very short
How would you rate the cleanliness of the facility?
*
Poor
1
2
3
4
Excellent
5
1 is Poor, 5 is Excellent
How comfortable did you feel during your visit?
*
Not comfortable
1
2
3
4
Very comfortable
5
1 is Not comfortable, 5 is Very comfortable
How satisfied are you with the overall quality of service?
*
1
2
3
4
5
Would you recommend our facility to others?
*
Yes
No
Not sure
Please share any suggestions or comments to help us improve.
Submit Survey
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