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Online Feedback
1.
Personal Information (Optional)
Name
Email Address
Phone Number
2.
Visit Details (Optional)
Date of visit
Reason for visit
3.
How easy was it to find and book an appointment?
Very easy
Easy
Neither easy nor difficult
Difficult
Very difficult
Any comments or suggestions for improving the appointment booking process?
4.
Did you receive adequate information prior to your appointment?
Yes
No
Any comments or suggestions for improving the mode or quality of pre appointment information?
5.
How easy were the directions & parking?
Very easy
Easy
Somewhat easy
Somewhat difficult
Difficult
Very difficult
Any comments or suggestions for improving directions to the clinic?
6.
Clinic environment - please tick areas below that met your expectations:
Cleanliness
Well maintained / Tidy
Warmth / comfort
Welcoming staff
Security
Wheelchair Access
Any comments or suggestions for improving our environment?
7.
Did the clinic run on time?
Early
On time
Late
Any comments or suggestions for improving waiting times?
8.
How would you rate the quality of your consultation?
Excellent
Good
Neutral
Poor
Very Poor
Any comments or suggestions for improving the quality of our care?
9.
Did you feel listened to and understood by the healthcare professional?
Yes
No
Any comments or suggestions for improving the consultation experience?
10.
How would you describe the follow-up contact you receieved?
Exceeded expectations
Met expectations
Below expectations
Any comments or suggestions for improving our follow-up contact?
11.
Would you recommend our practice to others?
Yes
No
Is there anything else you would like to share about your experience or any other suggestions for improvement?
12.
Do you consent to your feedback being used for training and quality improvement purposes?
Yes
No
13.
If required, are you happy to be contacted regarding your feedback?
Yes
No
If yes, please provide your preferred contact method (Email/Phone):
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