Patient Satisfactory Survey

We would like to know how you feel about the services we provide so we can make sure we are meeting your needs. Your responses are directly responsible for improving these services. All responses will be kept confidential and anonymous.nnThank you for your time.n
  • We would like to know how you feel about the services we provide so we can make sure we are meeting your needs. Your responses are directly responsible for improving these services. All responses will be kept confidential and anonymous.

    Thank you for your time.

  • PERSONAL DETAILS

  • CLINIC EVALUATION

    Please evaluate your experience regarding the quality of care you received during your most recent visit in our clinic.
    (Check the appropriate box with your level of agreement and explain if you want, the reason of your evaluation) Strongly Disagree / Disagree / Agree / Strongly agree / Comments (Explain the reason you Agree or Disagree)
  • HEALTH CARE EVALUATION

    Please evaluate your experience regarding the procedures related to your healthcare issue during your most recent visit.
    (Check the appropriate box with your level of agreement and explain if you want, the reason of your evaluation) Strongly Disagree / Disagree / Agree / Strongly agree / Comments (Explain the reason you Agree or Disagree)
  • FACILITIES EVALUATION

    Please evaluate your experience concerning cleanliness of the facilities, dietary enjoyment in relation to your most recent visit.
    (Check the appropriate box with your level of agreement and explain if you want, the reason of your evaluation) Strongly Disagree / Disagree / Agree / Strongly agree / Comments (Explain the reason you Agree or Disagree)