Satisfaction questionnaire

Dear Sir/Madam,
In an effort to continually improve the quality of our service, we ask you to complete the following questionnaire.
The form will remain anonymous and will be used solely to collect information and user feedback. In particular, we assure you that your comments, suggestions, and proposals will be carefully considered and taken into consideration.

We thank you in advance for your kind cooperation.

Satisfaction questionnaire

DATE OF VISIT:

DATE OF VISIT:

NATIONALITY:

NATIONALITY:

SEX

SEX

THE PLACE

Ease of reaching our headquarters

Ease of reaching our headquarters

NOT AT ALL SATISFIED
VERY SATISFIED

Accessibility of the facility

Accessibility of the facility

NOT AT ALL SATISFIED
VERY SATISFIED

Cleanliness and decorum of the rooms

Cleanliness and decorum of the rooms

NOT AT ALL SATISFIED
VERY SATISFIED
INFORMATION

Quality and accuracy of the information provided by the clinic

Quality and accuracy of the information provided by the clinic

NOT AT ALL SATISFIED
VERY SATISFIED

Quality of our website

Quality of our website

NOT AT ALL SATISFIED
VERY SATISFIED

Quality of available documentation

Quality of available documentation

NOT AT ALL SATISFIED
VERY SATISFIED
PEOPLE

Ability to respond to your urgent requests

Ability to respond to your urgent requests

NOT AT ALL SATISFIED
VERY SATISFIED

Response time to your request for services

Response time to your request for services

NOT AT ALL SATISFIED
VERY SATISFIED

Completeness and clarity of health information

Completeness and clarity of health information

NOT AT ALL SATISFIED
VERY SATISFIED
THE SERVICE

Courtesy of medical staff and clarity of their responses

Courtesy of medical staff and clarity of their responses

NOT AT ALL SATISFIED
VERY SATISFIED

Ability to understand your service request in detail

Ability to understand your service request in detail

NOT AT ALL SATISFIED
VERY SATISFIED

Behaviour of doctors

Behaviour of doctors

NOT AT ALL SATISFIED
VERY SATISFIED
PRIVACY RATING

How would you rate the respect for your privacy during the provision of the service?

How would you rate the respect for your privacy during the provision of the service?

NOT AT ALL SATISFIED
VERY SATISFIED
COMPARED TO YOUR EXPECTATIONS, THE SERVICE YOU RECEIVED WAS

Please select an option:

Please select an option:

ANY FURTHER SUGGESTIONS WELCOME:

ANY FURTHER SUGGESTIONS WELCOME: