Customer Satisfaction Survey

Question Title

* 1. How likely is it that you would recommend this clinic to a friend or colleague?

NOT AT ALL LIKELY

EXTREMELY LIKELY

Question Title

* 2. Overall, how satisfied or dissatisfied are you with this clinic??

Very satisfied

Somewhat satisfied

Neither satisfied nor dissatisfied

Somewhat dissatisfied

Very dissatisfied

Question Title

* 3. Which of the following words would you use to describe this clinic ? Select all that apply.

Reliable

High quality

Useful

Unique

Concerns were addressed

Impractical

Ineffective

Poor quality

Unreliable

Question Title

* 4. How well does the clinic meet your needs?

Extremely well

Very well

Somewhat well

Not so well

Not at all well

Question Title

* 5. How long have you been a patient of the clinic?

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

Question Title

* 6. How well were your needs met during your last appointment?

They were met

Not met

Exceeded expectations

Question Title

* 7. Do you have access to a smart phone and a private wifi connection?

Yes

Question Title

* 8. Do you have a laptop or desktop computer with a webcam and online access?

Yes

Question Title

* 9. How interested are you in online video appointments?

Extremely interested

Very interested

Somewhat interested

Not so interested

Not at all interested