This form is for you to tell us what you really think about our services.
It’s your health service so we need you to have your say on how we can do things better or tell us when we are getting things right.

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* 1. Date

Date

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* 2. What is the nature of your feedback?

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* 3. Are you?

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* 4. Who dd you see today?

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* 5. How did you travel to the Clinic today?

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* 6. How would you rate your visit today?

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* 7. Did you feel you were given enough time for your visit?

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* 8. Did you get all the information you needed?

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* 9. Overall how would you rate Gurriny?

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* 10. Tell us what we could do better / or any further comments.

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* 11. Would you like us to contact you regarding this matter?

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* 12. If you need to be contacted, please leave the best contact details

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