MORYING CLINIC - Patient Satisfaction Survey
MOR YING CLINIC
489, 489/1, 489/3 Moo 1, T. Mae Hia, A. Muang, Chiang Mai 50100
Tel : +66 93 134 5078, +66 62 939 5635
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Name - Surname
1) You’re *
2) Gender *
3) Age *
4) Contact *
*Email, Telephone
5) Address *
6) Country *
7) Medical coverage *
(Choose one or more)
8) Service Department *
(Choose one or more)
9) Please rank your satisfaction level of service from MOR YING CLINIC
Least
Most
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10) Will you recommend MOR YING CLINIC ?
Least
Most
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11) Staff or Department that you were impressed.
12) Please tell us about your impressive event.
13) How did you hear about us?
(Choose one or more)
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14) Overall Services
Service - Excellent (5), Good (4), Normal (3), Bad (20), Worst (1)
Worst
Excellent
Clear selection
14.1 Customer service
Service - Excellent (5), Good (4), Normal (3), Bad (20), Worst (1)
Worst
Excellent
Clear selection
14.2 Doctors
Service - Excellent (5), Good (4), Normal (3), Bad (20), Worst (1)
Worst
Excellent
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14.3 Nurses
Service - Excellent (5), Good (4), Normal (3), Bad (20), Worst (1)
worst
Excellent
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14.4 Pharmacy
Service - Excellent (5), Good (4), Normal (3), Bad (20), Worst (1)
Worst
Excellent
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14.5 Rehabilitation
Service - Excellent (5), Good (4), Normal (3), Bad (20), Worst (1)
Worst
Excellent
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14.6 Cashier
Service - Excellent (5), Good (4), Normal (3), Bad (20), Worst (1)
Worst
Excellent
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14.7 Environment
Service - Excellent (5), Good (4), Normal (3), Bad (20), Worst (1)
Worst
Excellent
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14.8 Cleaness
Service - Excellent (5), Good (4), Normal (3), Bad (20), Worst (1)
Worst
Excellent
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14.9 Hygine and Disinfection
Service - Excellent (5), Good (4), Normal (3), Bad (20), Worst (1)
Worst
Excellent
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14.10 Security
Service - Excellent (5), Good (4), Normal (3), Bad (20), Worst (1)
Worst
Excellent
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14.11 Rest rooms
Service - Excellent (5), Good (4), Normal (3), Bad (20), Worst (1)
Worst
Excellent
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14.12 Disable Facilities
Service - Excellent (5), Good (4), Normal (3), Bad (20), Worst (1)
Worst
Excellent
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14.13 Transportation
Service - Excellent (5), Good (4), Normal (3), Bad (20), Worst (1)
Worst
Excellent
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15) Your recommendation
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