Clinic Feedback Form - Innermost Healthcare

Clinic Feedback

Your Age *

Your Sex *

Clinic Date *

Please select how well we are doing in the following areas. (Great – 5, Good – 4, OK – 3, Fair – 2, Poor – 1)

Ease of getting care

Ease of making an appointment *

Suitability of appointment time *

Clinic opening times *

Clinic location *

Prompt return on calls *

Waiting

Time in waiting area *

Time in clinic area *

Waiting time for tests to be performed in clinic *

Waiting time for test results *

Staff

Provider (Consultant, Sonographer, Midwife)

Listens to you *

Takes enough time with you *

Explain what you want to know *

Gives you good advice and treatment *

Nurse

Friendly and helpful to you *

Answers your questions *

Office Staff

Friendly and helpful to you *

Answers your questions *

Payment

What you pay (Value for money) *

Explanation of charges *

Collection of payment/money *

Facility

Neat and clean Clinic premises (Spire Cardiff Hospital) *

Ease of finding where to go *

Comfort and Safety while waiting *

Privacy *

Confidentiality

Keeping my personal information private *

Recommendation

Likelihood to recommend a friend or relative to us *

Please tick this box if you are happy for us to publish your comments anonymously

What do you like best about our Clinic? *

What do you like least about our Clinic? *

Suggestions for improvement? *

Any other comments regarding any part of your experience with us? *

1 + 4 = ?Please prove that you are human by solving the equation *

Clinic Feedback

Ease of getting care

Waiting

Staff

Payment

Facility

Confidentiality

Recommendation

Services

Contact

Why Choose Us

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