PATIENTS FEEDBACK FORM
We value your feedback. Please take a moment to answer a few questions about our services.
Name
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Your answer
Area Visited *
Your answer
Reason for visit
What was the reason for your visit? *
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About appointment
Please tell us to what extent you agree or disagree with each of the following statements concerning your appointment
*
Strongly disagree
Disagree
Neutral
Agree
Strongly agree
It was easy to make my appointment
The waiting time was short
About the staff
Please tell us to what extent you agree or disagree with each of the following statements concerning the KNH staff
*
Strongly disagree
Disagree
Neutral
Agree
Strongly agree
The staffs were polite and respectful
My doctor listened, answered my questions and spends enough time with me
My doctor's explanations and instructions were clear
The nurses and medical assistants were attentive and caring
The staff that assisted me with billing and insurance were helpful
About the facility
Please tell us to what extent you agree or disagree with each of the following statements concerning the KNH facility
*
Strongly disagree
Disagree
Neutral
Agreed
Strongly agree
I found the hours of operation convenient
The waiting room was comfortable and the facility was clean
Signage and directions were easy to follow
Overall satisfaction
How would you rate the services we have provided so far? *
How likely are you to recommend us to a friend or colleague? *
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