Patient satisfaction survey

Please rate the following aspects of your visit to this clinic by selecting one of the options: Poor, Fair, Good, Very Good, or Excellent. If a question does not apply to your visit or you do not have an opinion, please select “Not Applicable / No Opinion.”

This field is for validation purposes and should be left unchanged.

Technician Name(Required)

Date(Required)

Patient Email Address

Booking Process

Waiting time: How long you had to wait to get an appointment at this clinic?(Required)

Did you receive clear instructions for the reason for the test?(Required)

Did the booking staff clearly explain how to prepare for the test(s). What to expect, medications to with-hold, activities to avoid?(Required)

Testing Process

Ease of getting information: Willingness of technical personnel to answer your questions?(Required)

Concern and caring by technical staff: Courtesy and respect you were given, friendliness and kindness; how well personnel listened to what you had to say and your concerns about testing?(Required)

Safety and security: The provisions for your safety and the security of your belongings?(Required)

Privacy: How well your privacy was considered?(Required)

Cleanliness: Was the testing area clean and free from clutter?(Required)

Instructions on leaving: Did the technologist let you know of any medication affects you may feel if applicable? Did the technologist give you any post-test instructions if applicable?(Required)

Waiting time: How long you had to wait in the clinic waiting area for your appointment?(Required)

Please answer the following questions by selecting Yes or No.

Were you told to leave the clinic before you felt ready to do so?(Required)

Yes

Would you recommend the clinic to a friend or family member if they needed services that it provides?(Required)

Yes

Overall quality of care: How you evaluate the services you received and the way you were treated?(Required)

If there were some things you could change about this visit to improve it, what would they be?