* 1. About You

  Under 18 19-34 35-54 55-74 75+
Female
Male

* 2. On what basis was payment made for your visit?

* 3. If you are insured, which insurance company are you insured by?

* 4. What influenced you to choose The London Orthopaedic Clinic

* 5. Would you recommend The London Orthopaedic Clinic to friends and family?

* 6. First Impressions?

  Very Good Good Fair Poor
Efficiency of appointment booking
Information given prior to arrival
convenience of appointment
Overall impression

* 7. On Arrival

  Very Good Good Fair Poor
Directions to appropriate floor
Greetings on arrival
Waiting room comfort
Promptness of attention
Overall impression

* 8. Availability of Amenities

  Very Good Good Fair Poor
Quality of refreshments
Papers/magazines
Disabled facilities
Conditions of restrooms/waiting area
Overall impressions

* 9. Consultant Care - Speed in which you were seen

* 10. Which Consultant did you see?

* 11. Consultant Care

  Very Good Good Fair Poor
Explanation of presenting condition and treatment options
Level of privacy when undressing
Overall consultant care

* 12. Nursing care - speed in which you were seen

* 13. Nursing Care

  Very Good Good Fair Poor
Explanation of procedure
Explanation of aftercare
Time & attention given
Cleanliness
Overall nursing care

* 14. Radiology - Speed in which you were seen

* 15. Radiology

  Very Good Good Fair Poor
Explanation of procedure
Time & attention given
Cleanliness
Courtesy of staff
Overall Care

* 16. Financial administration

  Very Good Good Fair Poor
Assistance with financial queries
Ease of financial arrangements

* 17. Comments & Suggestions

* 18. If you would like to be contacted about any of these points please include your name and address below.

* 19. Please let us know if you are happy for your comments to be used on our website ( N.B No names or details will be mentioned)

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