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Online Feedback
1.
Personal Information (Optional)
Name
Email Address
Phone Number
2.
Visit Details
Date Of Visit
Name of GP/Nurse/Staff memebr
Reason for Visit
3.
How easy was it to book your appointment?
Very easy
Easy
Neither easy nor difficult
Difficult
Very difficult
Any comments or suggestions for improving the appointment booking process?
4.
How would you rate the waiting time for your appointment?
Very Short
Short
Neutral
Long
Very Long
Any comments or suggestions for improving waiting times?
5.
How would you rate the quality of your consultation?
Excellent
Good
Neutral
Poor
Very Poor
6.
Did you feel listened to and understood by the healthcare professional?
Yes
No
Any comments or suggestions for improving the consultation experience?
7.
Would you recommend our practice to others?
Yes
No
8.
Is there anything else you would like to share about your experience or any other suggestions for improvement?
9.
Do you consent to your feedback being used for training and quality improvement purposes?
Yes
No
10.
If required are you happy to be contacted regarding your feedback?
Yes
No
If yes, please provide your preferred contact method (Email/Phone):
