Customer Satisfaction Survey
*
1.
On a scale of 0 to 10,
How likely is it that you would recommend this clinic to a friend or colleague?
0 for Not at all likely, 10 for Extremely likely
(Required.)
Not at all likely
Extremely likely
0
1
2
3
4
5
6
7
8
9
10
*
2.
Overall, how satisfied or dissatisfied are you with this clinic??
(Required.)
Very satisfied
Somewhat satisfied
Neither satisfied nor dissatisfied
Somewhat dissatisfied
Very dissatisfied
*
3.
Which of the following words would you use to describe this clinic ? Select all that apply.
(Required.)
Reliable
High quality
Useful
Unique
Concerns were addressed
Impractical
Ineffective
Poor quality
Unreliable
*
4.
How well does the clinic meet your needs?
(Required.)
Extremely well
Very well
Somewhat well
Not so well
Not at all well
*
5.
How long have you been a patient of the clinic?
(Required.)
This is my first visit
Less than six months
Six months to a year
1 - 2 years
3 or more years
I haven't had a visit
*
6.
How well were your needs met during your last appointment?
(Required.)
They were met
Not met
Exceeded expectations
*
7.
Do you have access to a smart phone and a private wifi connection?
(Required.)
Yes
No
*
8.
Do you have a laptop or desktop computer with a webcam and online access?
(Required.)
Yes
No
*
9.
How interested are you in online video appointments?
(Required.)
Extremely interested
Very interested
Somewhat interested
Not so interested
Not at all interested
Current Progress,
0 of 9 answered
