Patient Feedback Questionnaire

Please tick the phrase you most agree with:

How easy was it to make your appointment?

Very Easy

Fairly Easy

Not Very Easy

Not At All Easy

Haven't Tried

How would you rate the service you received from the reception staff?

Very Good

Good

Average

Below Average

Disappointing

How long did you have to wait to be seen?

Seen on Time

Less than 10 minutes

10 to 20 minutes

20 to 30 minutes

More than 30 minutes

How satisfied were you with the consultation you received?

Very Satisfied

Fairly Satisfied

Neither Satisfied nor Dissatisfied

Fairly Dissatisfied

Very Dissatisfied

Did you feel that you were treated with dignity and respect?

Yes

No

How clean did you find the clinic?

Very Good

Good

Average

Below Average

Disappointing

Your Comments

Please add any comments as how you think we can improve the service we deliver at The London Road Clinic

Question or Comments *

Your Details

This survey is confidential but if you have a particular comment or observation you would like us to address or if you are happy for us to contact you with regard to developing our services in the future, kindly complete your contact details:

Your Name Address Post Code Telephone *