Bloom Healthcare Feedback
Your Name (can be anonymous)
First Name
Last Name
Email
example@example.com
Mobile Number
Name of Clinician
State
*
Please Select
Australian Capital Territory
New South Wales
Northern Territory
Queensland
South Australia
Tasmania
Victoria
Western Australia
Feedback
*
Would you like to be contacted to discuss your feedback further
*
Yes
No
Based on your experience, how satisfied are you with the service you received from Bloom Healthcare?
Not Satisfied
0
1
2
3
4
5
6
7
8
9
Highly Satisfed
10
0 is Not Satisfied, 10 is Highly Satisfed
How likely would you re-refer or recommend Bloom Healthcare to others?
Not Likely
0
1
2
3
4
5
6
7
8
9
Highly Likely
10
0 is Not Likely, 10 is Highly Likely
Submit
Should be Empty: