SHIP DERMATOLOGY FEEDBACK FORM
In this page, you can rate and comment about the quality of services provided by the staff, as well as the cleanliness and turn-around time of the clinic operations. You may answer anonymously. Responses will be recorded and be used to further improve the quality of the services provided.
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1. Name (Optional)
2. Date of Visit/Consult
MM
/
DD
/
YYYY
Time
:
3. Nature of visit *
Required
4. Staff Member/s Who Assisted You *
Required
5. Cleanliness of the Clinic *
6. Booking An Appointment *
7. Turn around time *
8. Quality of Service Provided *
Refers to question number 3
9. Customer Service Provided by Staff *
Refers to question number 4
10. Ease of transaction/paying the bill *
Other Comments/Suggestions/Recommendations about the Clinic, the Staff, and/or the Services.
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