Patient Questionnaire
Exit this survey

Your doctor

This page will help us to feed back to your doctor how well they help you

1. Please answer the following questions about your usual doctor

	Excellent	Very Good	Good	Average	Poor	N/A
Their knowledge about you and your needs	*Please answer the following questions about your usual doctor Their knowledge about you and your needs Excellent	Their knowledge about you and your needs Very Good	Their knowledge about you and your needs Good	Their knowledge about you and your needs Average	Their knowledge about you and your needs Poor	Their knowledge about you and your needs N/A
Their level of caring	Their level of caring Excellent	Their level of caring Very Good	Their level of caring Good	Their level of caring Average	Their level of caring Poor	Their level of caring N/A
How well they listen	How well they listen Excellent	How well they listen Very Good	How well they listen Good	How well they listen Average	How well they listen Poor	How well they listen N/A
How well they explain things to you	How well they explain things to you Excellent	How well they explain things to you Very Good	How well they explain things to you Good	How well they explain things to you Average	How well they explain things to you Poor	How well they explain things to you N/A

Please give further comments here if necessary

Powered by SurveyMonkey
Create your own free online survey now!

form {display:none;} #jserror {text-align:center;margin-top:50px;}Javascript is required for this site to function, please enable.