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Professionals in Multi-Disciplinary Health Care

Feedback Form

Dear Patient, Thank you for taking the time to fill out this anonymous survey, which aims to ensure that we are providing high quality health service to clients. We can use your feedback to identify areas that can be improved in order to better meet the needs of our patients.

Please indicate Quality of Service received by placing a number, between 1-10, in the box (1=VERY POOR to 10=EXCELLENT)

Feedback form:

Appointments:
Ability to contact the practice by phone to book in appointments:  
Availability of appointment times:  
Time waiting for the Practitioner:  
Access:
Convenience of the practice’s operating hours:  
Parking facilities:  
Ability to find the practice:  
Receptionist:
The receptionist’s abilities to deal with your needs:  
The receptionist’s manner and demeanor:  
Facilites:
The safety and comfort level of the facilities:  
Your satisfaction of privacy given during your visit:  
Treatment:
Explanation regarding your condition:  
Explanation regarding your treatment:  
Amount of time spent with you:  
The results of your treatment:  
Additional comments: optional
 
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