TELL US WHAT YOU THINK - Health and Dental Services

Medical, Dental and Allied Health

Thanks for taking your time to complete the customer feedback survey. This survey is anonymous and is a helpful way to improve our services for you.

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1. Clinic or service visited

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2. Date visited

Date / Time

Date

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3. How satisfied were you with the following?

	Very satisfied	Satisfied	Neutral	Unsatisfied	Very unsatisfied
Wait time in clinic for services	Wait time in clinic for services Very satisfied	Wait time in clinic for services Satisfied	Wait time in clinic for services Neutral	Wait time in clinic for services Unsatisfied	Wait time in clinic for services Very unsatisfied
Friendly and warm staff	Friendly and warm staff Very satisfied	Friendly and warm staff Satisfied	Friendly and warm staff Neutral	Friendly and warm staff Unsatisfied	Friendly and warm staff Very unsatisfied
Feeling safe and supported	Feeling safe and supported Very satisfied	Feeling safe and supported Satisfied	Feeling safe and supported Neutral	Feeling safe and supported Unsatisfied	Feeling safe and supported Very unsatisfied
Overall satisfaction	Overall satisfaction Very satisfied	Overall satisfaction Satisfied	Overall satisfaction Neutral	Overall satisfaction Unsatisfied	Overall satisfaction Very unsatisfied

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4. How likely are you to recommend us to your family and friends?

Extremely likely

Likely

Neither likely nor unlikely

Unlikely

Extremley unlikely

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5. How did you hear about us?

Event

Flyer

Friend/Family

Google search

Social media

Website

Other (please specify)

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6. What other comments or suggestions do you have? What other services would you like provided?

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7. What is one thing we did really well?

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8. Want to yarn with someone? (Optional)

Name

Phone

Thank you for participating in our survey. The information you provide will enable us to provide a better service. ATSICHS Brisbane will not be able to personally identify you by the information you provide in your responses to this survey, unless you choose to provide your details and request us to contact you.

We will not disclose your personal information to third parties without your consent.

ATSICHS Brisbane is committed to protecting your privacy in accordance with the Information Privacy Principles of the Information Privacy Act 2009.