Clinic Feedback Form
We would love to hear your thoughts, suggestions, concerns or problems with anything related to your clinic experience so we can improve!
Full Name
*
First Name
Last Name
Hospital Card No
Phone Number
*
Consultant Clinic
Please Select
Dr. Olufemi Oderinlo
Dr. Ogugua Okonkwo
Dr. Mildred Ulaikere
Dr. Fatai Oluyadi
Dr. Adunola Ogunro
Dr. Abimbola Ashaye
Dr. Tayo Bogunjoko
Dr. Ayo Akinye
Dr. Toyin Akanbi
Dr. Kunle Hassan
Dr. Feyidamilola Hassan-Oyewumi
Others
Please kindly select the clinic
Other Doctors & Clinics
Kindly specify
Appointment Date
-
Day
-
Month
Year
Date
Email
example@example.com
EYE FOUNDATION HOSPITAL LOCATION
Please Select
Eye Foundation Hospital Ikeja
Eye Foundation Hospital Lekki (providence street)
Eye Foundation Hospital (Lekki Admiralty way)
Eye Foundation Hospital Ikorodu
Eye Foundation Hospital Ijebu Imushin
Eye Foundation Hospital Abeokuta
Eye Foundation Hospital Abuja (APO legislative quarters
Eye Foundation Hospital Abuja (Gwarinpa)
Please kindly select the hospital branch you visited
On a scale of 1-5, how would you rate our services? HYGIENE
Worst
1
2
3
4
Best
5
1 is Worst, 5 is Best
On a scale of 1-5, how would you rate our services? Time Management
Worst
1
2
3
4
Best
5
1 is Worst, 5 is Best
On a scale of 1-5, how would you rate our services? FRIENDLINESS
Worst
1
2
3
4
Best
5
1 is Worst, 5 is Best
On a scale of 1-5, how would you rate our services? Professionalism
Worst
1
2
3
4
Best
5
1 is Worst, 5 is Best
How did you hear about us?
RADIO
NEWSPAPER PUBLICATIONS
SOCIAL MEDIA
OTHER HOSPITAL REFERRALS
FRIENDS AND FAMILY REFERRALS
Why did you choose us?
LOCATION
PRICE OF SERVICES
REFERRALS
Were you attended to promptly when it got to your turn?
YES
NO
If NO, Which section(s) do you feel you were been delayed?
1) SECTION/DEPARTMENT
2) SECTION/DEPARTMENT
Do you have any concerns, related to your care or other services you felt were not properly addressed by our staff?
Please tell us the single most important action we took that made you feel better and satisfied.
What could we have done differently that would have made you satisfied with our servicestoday?
Will you recommend us to your friends and family?
YES
NO
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