Patient Appointment Feedback Survey 2018

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* 2. How was your experience with your practitioner based on efficiency, professionalism & care? (1 Star = Poor, 5 Stars = Outstanding)

Would you like to add any comments?

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* 3. How would you rate your experience with our admin/front desk team based on their helpfulness & friendliness? (1 Star = Poor, 5 Stars = Outstanding)

Would you like to add any comments?

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* 4. What encouraged you choose Southside Clinic for your health care needs? (Please choose all that apply)

You showed up on my Google search

Price

Was dissatisfied with a previous therapist

Location

I was recommended to Southside Clinic

Wanted to try a different type of therapy

Friendly receptionist when I first made contact

Other (please specify)

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* 5. How do you rate us in the following areas:

	Extremely Poor	Poor	Fair	Good	Excellent	N/A
Location of the clinic	Location of the clinic Extremely Poor	Location of the clinic Poor	Location of the clinic Fair	Location of the clinic Good	Location of the clinic Excellent	Location of the clinic N/A
Car Parking at the clinic	Car Parking at the clinic Extremely Poor	Car Parking at the clinic Poor	Car Parking at the clinic Fair	Car Parking at the clinic Good	Car Parking at the clinic Excellent	Car Parking at the clinic N/A
Opening hours	Opening hours Extremely Poor	Opening hours Poor	Opening hours Fair	Opening hours Good	Opening hours Excellent	Opening hours N/A
Availability of appointments	Availability of appointments Extremely Poor	Availability of appointments Poor	Availability of appointments Fair	Availability of appointments Good	Availability of appointments Excellent	Availability of appointments N/A
Friendliness of staff	Friendliness of staff Extremely Poor	Friendliness of staff Poor	Friendliness of staff Fair	Friendliness of staff Good	Friendliness of staff Excellent	Friendliness of staff N/A
Efficiency of the receptionist	Efficiency of the receptionist Extremely Poor	Efficiency of the receptionist Poor	Efficiency of the receptionist Fair	Efficiency of the receptionist Good	Efficiency of the receptionist Excellent	Efficiency of the receptionist N/A
Skill of your practitioner	Skill of your practitioner Extremely Poor	Skill of your practitioner Poor	Skill of your practitioner Fair	Skill of your practitioner Good	Skill of your practitioner Excellent	Skill of your practitioner N/A
Management of your pain or discomfort	Management of your pain or discomfort Extremely Poor	Management of your pain or discomfort Poor	Management of your pain or discomfort Fair	Management of your pain or discomfort Good	Management of your pain or discomfort Excellent	Management of your pain or discomfort N/A
Explaining your condition and treatment to you	Explaining your condition and treatment to you Extremely Poor	Explaining your condition and treatment to you Poor	Explaining your condition and treatment to you Fair	Explaining your condition and treatment to you Good	Explaining your condition and treatment to you Excellent	Explaining your condition and treatment to you N/A
Cost of services	Cost of services Extremely Poor	Cost of services Poor	Cost of services Fair	Cost of services Good	Cost of services Excellent	Cost of services N/A
Waiting time before your treatment	Waiting time before your treatment Extremely Poor	Waiting time before your treatment Poor	Waiting time before your treatment Fair	Waiting time before your treatment Good	Waiting time before your treatment Excellent	Waiting time before your treatment N/A
Making you feel special	Making you feel special Extremely Poor	Making you feel special Poor	Making you feel special Fair	Making you feel special Good	Making you feel special Excellent	Making you feel special N/A
Waiting room music	Waiting room music Extremely Poor	Waiting room music Poor	Waiting room music Fair	Waiting room music Good	Waiting room music Excellent	Waiting room music N/A
Waiting room magazines	Waiting room magazines Extremely Poor	Waiting room magazines Poor	Waiting room magazines Fair	Waiting room magazines Good	Waiting room magazines Excellent	Waiting room magazines N/A
Waiting room chairs	Waiting room chairs Extremely Poor	Waiting room chairs Poor	Waiting room chairs Fair	Waiting room chairs Good	Waiting room chairs Excellent	Waiting room chairs N/A
General ambiance of the clinic	General ambiance of the clinic Extremely Poor	General ambiance of the clinic Poor	General ambiance of the clinic Fair	General ambiance of the clinic Good	General ambiance of the clinic Excellent	General ambiance of the clinic N/A
On-Hold Telephone Music	On-Hold Telephone Music Extremely Poor	On-Hold Telephone Music Poor	On-Hold Telephone Music Fair	On-Hold Telephone Music Good	On-Hold Telephone Music Excellent	On-Hold Telephone Music N/A

Any comments...

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* 6. How likely are you to recommend a friend or colleague to Southside Clinic? (1 Star = Never, 5 Stars = I already have)

Would you like to add any comments?

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* 7. Thank you for taking the time to offer us feedback. If you have any other comments please let us know below.

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* 8. If you would like us to follow up on any feedback you have offered, please leave your contact details below:

Name

Email Address

Phone Number

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* 1. Who did you see for your most recent appointment?

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* 2. How was your experience with your practitioner based on efficiency, professionalism & care? (1 Star = Poor, 5 Stars = Outstanding)

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* 3. How would you rate your experience with our admin/front desk team based on their helpfulness & friendliness? (1 Star = Poor, 5 Stars = Outstanding)

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* 4. What encouraged you choose Southside Clinic for your health care needs? (Please choose all that apply)

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* 5. How do you rate us in the following areas:

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* 6. How likely are you to recommend a friend or colleague to Southside Clinic? (1 Star = Never, 5 Stars = I already have)

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* 7. Thank you for taking the time to offer us feedback. If you have any other comments please let us know below.

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* 8. If you would like us to follow up on any feedback you have offered, please leave your contact details below: