Professionals in Multi-Disciplinary Health Care

Feedback Form

Dear Patient, Thank you for taking the time to fill out this anonymous survey, which aims to ensure that we are providing high quality health service to clients. We can use your feedback to identify areas that can be improved in order to better meet the needs of our patients.

Please indicate Quality of Service received by selecting a number,
between 1-10 (1=VERY POOR to 10=EXCELLENT)

Appointments:

Ability to contact the practice by phone to book in appointments:
12345678910

Availability of appointment times:
12345678910

Time waiting for the Practitioner:
12345678910

Access:

Convenience of the practice's operating hours:
12345678910

Parking facilities:
12345678910

Ability to find the practice:
12345678910

Receptionist:

The receptionist's abilities to deal with your needs:
12345678910

The receptionist's manner and demeanor:
12345678910

Facilites:

The safety and comfort level of the facilities:
12345678910

Your satisfaction of privacy given during your visit:
12345678910

Treatment:

Explanation regarding your condition:
12345678910

Explanation regarding your treatment:
12345678910

Amount of time spent with you:
12345678910

The results of your treatment:
12345678910

Additional comments: optional