Patient Satisfaction Form - Consultation 2023

1
We sincerely hope your experience at the Academy has been a good one and we have been able to fulfil all your expectations.

We are always trying to improve the complete experience and we would be grateful for your anonymous feedback, which will be very useful to us.

The questionnaire should not take more than a few minutes to complete and is completely anonymous if you wish to leave your name blank.

Many thanks.

Richard, David, Ian, Irene, Stella, Leigh-Ann, Joanne, Rachel, Natalia, Andreea and Lauren.
2
Satisfaction?* This field is required.How satisfied are you with our overall service?
1
2
3
4
5
Unacceptable
Excellent
3
Efficient?* This field is required.How easy and convenient was it to make an appointment
Very Easy
Fairly Easy
Not easy
4
Timing?* This field is required.We aim to see all patients at their appointed time. How long did you have to wait before you were seen?
I was seen on time
I was seen acceptably late
I was seen unacceptably late
5
Consultation?* This field is required.The time taken for your consultation was
Too short
Too long
About the right length of time
6
Courtesy?During your visit, were you treated professionally and with respect by our staff?
1
2
3
4
5
No, not at all
Yes, at all times
7
Treatment?If treatment was carried out how satisfied are you with the outcome?
1
2
3
4
5
Not Satisfied
Very Satisfied
8
Hygiene?How would you rate our standards of hygiene and cross-infection control.
1
2
3
4
5
Unacceptable
Excellent
9
Have we got things right, or how can we improve?Please write a few things that you think we should improve or what you liked in our practice:
10
If you wish to be contacted to discuss your feedback please add your name and email address. First Name Last Name Phone Number
Should be Empty:

We sincerely hope your experience at the Academy has been a good one and we have been able to fulfil all your expectations.