Customer Satisfaction Survey

We're committed to monitoring the quality of the services and products we provide, as part of an ongoing improvement process. We would appreciate your feedback on our performance.

1. Please rate the following aspects of our work.

	Excellent	Good	Adequate	Poor	Unacceptable	N/A
Service you received when calling to make an appointment	*Please rate the following aspects of our work. Service you received when calling to make an appointment Excellent	Service you received when calling to make an appointment Good	Service you received when calling to make an appointment Adequate	Service you received when calling to make an appointment Poor	Service you received when calling to make an appointment Unacceptable	Service you received when calling to make an appointment N/A
Greeting you received from Reception on arrival	Greeting you received from Reception on arrival Excellent	Greeting you received from Reception on arrival Good	Greeting you received from Reception on arrival Adequate	Greeting you received from Reception on arrival Poor	Greeting you received from Reception on arrival Unacceptable	Greeting you received from Reception on arrival N/A
Service you received at Reception on departure	Service you received at Reception on departure Excellent	Service you received at Reception on departure Good	Service you received at Reception on departure Adequate	Service you received at Reception on departure Poor	Service you received at Reception on departure Unacceptable	Service you received at Reception on departure N/A
Your skin consultation	Your skin consultation Excellent	Your skin consultation Good	Your skin consultation Adequate	Your skin consultation Poor	Your skin consultation Unacceptable	Your skin consultation N/A
Your skin treatment	Your skin treatment Excellent	Your skin treatment Good	Your skin treatment Adequate	Your skin treatment Poor	Your skin treatment Unacceptable	Your skin treatment N/A
Quality of our responses to your questions and concerns	Quality of our responses to your questions and concerns Excellent	Quality of our responses to your questions and concerns Good	Quality of our responses to your questions and concerns Adequate	Quality of our responses to your questions and concerns Poor	Quality of our responses to your questions and concerns Unacceptable	Quality of our responses to your questions and concerns N/A
Treatment and Product knowledge of Nurse	Treatment and Product knowledge of Nurse Excellent	Treatment and Product knowledge of Nurse Good	Treatment and Product knowledge of Nurse Adequate	Treatment and Product knowledge of Nurse Poor	Treatment and Product knowledge of Nurse Unacceptable	Treatment and Product knowledge of Nurse N/A
Ability to anticipate your needs and respond proactively	Ability to anticipate your needs and respond proactively Excellent	Ability to anticipate your needs and respond proactively Good	Ability to anticipate your needs and respond proactively Adequate	Ability to anticipate your needs and respond proactively Poor	Ability to anticipate your needs and respond proactively Unacceptable	Ability to anticipate your needs and respond proactively N/A
Level of satisfaction with your homecare products	Level of satisfaction with your homecare products Excellent	Level of satisfaction with your homecare products Good	Level of satisfaction with your homecare products Adequate	Level of satisfaction with your homecare products Poor	Level of satisfaction with your homecare products Unacceptable	Level of satisfaction with your homecare products N/A
Providing value for money	Providing value for money Excellent	Providing value for money Good	Providing value for money Adequate	Providing value for money Poor	Providing value for money Unacceptable	Providing value for money N/A
Responding promptly to problems	Responding promptly to problems Excellent	Responding promptly to problems Good	Responding promptly to problems Adequate	Responding promptly to problems Poor	Responding promptly to problems Unacceptable	Responding promptly to problems N/A
Overall how would you rate our services to you	Overall how would you rate our services to you Excellent	Overall how would you rate our services to you Good	Overall how would you rate our services to you Adequate	Overall how would you rate our services to you Poor	Overall how would you rate our services to you Unacceptable	Overall how would you rate our services to you N/A

Any Additional comments

2. What level of confidence do you have in us to deliver the products and services that you require?

What level of confidence do you have in us to deliver the products and services that you require? Complete

A lot

Some

Little

None

3. Overall, is our performance ...

Overall, is our performance ... Getting much better?

Getting better?

Staying at about the same level?

Getting worse?

Getting much worse?

4. Based on our performance, how likely is it that you will use us in the future?

Based on our performance, how likely is it that you will use us in the future? Certain

Very likely

Somewhat likely

Unlikely

Very unlikely

5. If you have any suggestions regarding how we could improve the services we provide to you, please enter them in the box below.

If you have any suggestions regarding how we could improve the services we provide to you, please enter them in the box below.

6. To receive your Gift Voucher, please enter all the details below. Your Gift Voucher will be sent to your mail address within 7 days. You are welcome to submit your survey anonymously but we will not be able to send a Gift Voucher.

To receive your Gift Voucher, please enter all the details below. Your Gift Voucher will be sent to your mail address within 7 days. You are welcome to submit your survey anonymously but we will not be able to send a Gift Voucher. Name:
Address:
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City/Town:
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ZIP/Postal Code:
Country:
Email Address:
Phone Number: