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* 1. Which practitioner did you see? (tick all that apply)

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* 2. How did you hear about us?

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* 3. Did you make initial contact by

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* 4. Ease of getting care

  Very easy Easy Average Difficult Very difficult
Were you able to find our contact details easily?
Were you able to contact us easily?
How easy was it to make an appointment?

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* 5. Waiting

  Excellent Good Average Below Average Not Acceptable
Time in waiting room
Waiting for consultation report
Waiting for test results

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* 6. Practitioner

  Excellent Good Average Below Average Not Acceptable
Listens to you
Understands your concerns
Explains what you want to know
Gives you good advice and treatment
Prompt return of calls or emails
Exceeds your expectations

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* 7. Reception or other staff you dealt with

  Excellent Good Average Below Average Not Acceptable
Friendly and helpful to you
Answer your questions

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* 8. Rate your experience

  Excellent Good Average Below Average Not Acceptable
Value for money
Quality of experience

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* 9. What would stop you returning for further treatment?

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* 10. The likelihood of referring your friends and relatives to us

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* 11. What do you like best about our clinic?

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* 12. What do you like least about our clinic, and do you have any ideas how we can improve this?

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* 13. Anything else? Please write here anything you would like to share about your experience of having treatment with us

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* 14. May we quote you?

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