MediHome Clinic Feedback Form 一家诊所反馈表格

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MediHome Clinic Feedback Form 一家诊所反馈表格

Thank you for visiting MediHome clinic! Your health and satisfaction are our top priorities, and we are committed to providing the best possible care. To help us improve our services, we kindly invite you to share your feedback about your recent visit.

感谢您光临一家诊所！您的健康和满意度是我们的首要任务，我们致力于提供最佳的护理服务。为了帮助我们改进服务，我们诚邀您分享您最近一次就诊的反馈。

When did you last visit MediHome Clinic?

您上次访问一家诊所是什么时候？

Within the last week 近一周内

More than a week ago and within the last month 多过一周前，近一个月内

More than a month ago but within the last 3 months 多过一个月前，近三个月內

More than 3 months ago 多过三个月前

Other:

1. Doctor's Service 医生的服务

Please share constructive feedback for our doctor's service
请分享对我们医生服务的建设性反馈

How clearly did the doctor explain your condition and treatment?

医生解释您的病情和治疗方案的清晰度如何？

Very Clearly 非常清楚

Clearly 清楚

Somewhat Clearly 有点清楚

Not Clearly 不清楚

Other:

How satisfied are you with the doctor's service?

您对医生的服务满意吗？

Very Satisfied 非常满意

Satisfied 满意

Neutral 一般

Dissatisfied 不满意

Other:

Any other feedback on the doctor's service?

对医生的服务还有其他反馈吗？

2. Clinic Assistant's Service

诊所助理的服务

Please share constructive feedback for our clinic assistant's service
请分享对我们诊所助理服务的建设性反馈

How would you rate the helpfulness of the clinic assistants?

您如何评价诊所助理给予的帮助？

Excellent 非常好

Good 好

Fair 一般

Poor 不好

Other:

How courteous were the clinic assistants? *

Very Courteous 很有礼貌

Courteous 有礼貌

Neutral 一般

Discourteous 没有礼貌

Other:

Any other feedback on the clinic assistant's service?
对诊所助理的服务还有其他反馈吗？

3. Ambience and Cleanliness 氛围和清洁度

Please share constructive feedback for our clinic's ambience and cleanliness
请分享对我们诊所的氛围和清洁度的建设性反馈

How would you rate the overall ambience of the clinic?
您如何评价诊所的整体氛围？
*

Excellent 非常好

Good 好

Fair 一般

Poor 不好

Other:

How would you rate the cleanliness of the clinic?
您如何评价诊所的清洁度？
*

Very Clean 非常干净

Clean 干净

Neutral 一般

Unclean 不干净

Other:

Any other feedback on the clinic's ambience and cleanliness?
对于诊所的氛围和清洁度还有其他反馈吗？

4. General Questions 一般的问题

Please share any general constructive feedback for our clinic
请分享对我们诊所的任何一般建设性反馈

How easy was it to schedule an appointment?
安排预约有多容易？
*

Very easy 非常容易

Easy 容易

Neutral 一般

Difficult 困难

I did not make an appointment 我没有预约

Other:

How would you rate the overall efficiency of the clinic?
您如何评价诊所的整体效率？
*

Excellent 非常好

Good 好

Fair 一般

Poor 不好

Other:

How likely are you to recommend our clinic to others?
您向其他人推荐我们诊所的可能性有多大？
*

Very likely 很可能

Likely 可能

Unlikely 不太可能

Will not recommend 不可能

Other:

Any other feedback for the clinic in general?
一般而言，诊所还有其他反馈吗？

Thank you for your invaluable feedback!
Would you like us to follow-up with you on your feedback?

感谢您的宝贵反馈！您希望我们跟进您的反馈吗？
*

Yes, please 是的，请跟进

No, I'm fine 不需要

If you answered "Yes" to the above questions or would like to be eligible for the feedback form incentive, please provide your WhatsApp number registered with the clinic.
如果您对上述问题的回答为“是”，或者希望有资格获得反馈表奖励，请提供您在诊所注册的 WhatsApp 号码

We value your data privacy. The contact number collected will be used solely for follow-up purposes and/or feedback form incentive verification.
我们重视您的数据隐私。收集的联系电话将仅用于后续联络或反馈形式激励验证。

Whatsapp/Mobile Number:
手机号码:

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