Patient Satisfaction Survey
Your eperience
Email address *
1. Based on your most recent experience in what city was the clinic you visited located ?
2. During what time of day did you contact Care Plus Clinic by telephone ?
3. To what extent did we fulfill your expectations with the friendliness and courtesy of the representative assisting you with your phone inquiry ?
Below Expectations
Beyond Expectations
4. To what extent did we fulfill your expectations in displaying compassion and empathy in assisting you with your phone inquiry ?
Below Expectations
Beyond Expectations
5. To what extent did we fulfill your expectations in providing you with the information regarding your phone inquiry ?
Below Expectations
Beyond Expectations
6. How would you rate our ability to fulfill your overall expectations of your phone call ?
Below Expectations
Beyond Expectations
7. What day of the week did your most recent visit take place ?
8. During what time of day was your most recent visit ?
9. Please indicate the date of your most recent visit ?
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10. During your most recent Care Plus Clinic visit to what extent did we fulfill your expectations in treating you with courtesy and respect ?
Below Expectations
Beyond Expectations
11. During your most recent Care Plus Clinic visit to what extent did we fulfill your expectations in displaying compassion and empathy in assisting you?
Below Expectations
Beyond Expectations
12. During your most recent visit to what extent did we fulfill your expectations in providing you with a sense that our Care Plus Clinic team was genuinely interested in helping you ?
Below Expectations
Beyond Expectations
13. During your most recent Care Plus Clinic visit did we fulfill your expectations in keeping you informed of the wait time ?
Below Expectations
Beyond Expectations
14. During your most recent Care Plus Clinic visit to what extent did we fulfill your expectations with the comfort and cleanliness of the reception area ?
Below Expectations
Beyond Expectations
15. During your most recent Care Plus Clinic visit to what extent did we fulfill your expectations in providing you with an accurate estimation of time in which you would be waiting to see a health care provider ?
Below Expectations
Beyond Expectations
16. During your most recent visit did your healthcare provider fulfill your expectations in explaining things in a way that was easy to understand ?
Below Expectations
Beyond Expectations
17. During your most recent visit to what extent were you satisfied with your healthcare providers ability to listen carefully to your specific concern ?
Below Expectations
Beyond Expectations
18. During your most recent visit to what extent did your healthcare provider treat you with courtesy and respect ?
Below Expectations
Beyond Expectations
19. How likely would you be to recommend Care Plus Clinic to your family and friends ?
Below Expectations
Beyond Expectations
20. Is there anything else you wish to share with us regarding your recent experience with Care Plus Clinic or suggestions on how we can better provide quality family care? (Please explain)
Your answer
21. Is there any member of our Medicentres team that went beyond expectations during you recent visit that you feel deserves to be recognized for their commitment in providing quality family care? (Please provide their name and any specific details that will help us recognize their efforts)
Your answer
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