Patient Satisfaction Questionnaire

Patient Satisfaction Questionnaire
Name (optional)

First NameLast Name
Email (optional)
example@example.com
Questionnaire
Which service/s did you see?
Please rate out of five (one being poor and five being excellent). How would you rate:
The waiting time for appointments?

1

2

3

4

5

1 is Poor, 5 is Excellent.
Assessment carried out, management provided and follow up care?

1

2

3

4

5

1 is Poor, 5 is Excellent.
Remote appointments via phone or video (if applicable)?

1

2

3

4

5

1 is Poor, 5 is Excellent.
Appropriateness of the facilities?

1

2

3

4

5

1 is Poor, 5 is Excellent.
Convenience of the facilities?

1

2

3

4

5

1 is Poor, 5 is Excellent.
The quality of written information provided?

1

2

3

4

5

1 is Poor, 5 is Excellent.
How well we dealt with queries via phone, email or remote care?

1

2

3

4

5

1 is Poor, 5 is Excellent.
The professionalism of administrative staff?

1

2

3

4

5

1 is Poor, 5 is Excellent.
The professionalism of clinical staff?

1

2

3

4

5

1 is Poor, 5 is Excellent.
The product or equipment we have provided for you (if applicable)?

1

2

3

4

5

1 is Poor, 5 is Excellent.
Would you recommend our service to your friends or family?

YesNo
We're keen to ensure our service is 'excellent' and would value your help with this. What does your ideal Audiology service look like and what would make the service 'excellent' for you?
Are there any other comments that you would like to add?
Please verify that you are human*
Should be Empty: