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Patient Feedback Form
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1
Please rate how long you had to wait to get an appointment at this clinic.
Did you wait long to get an appointment with us?
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2
Please rate how long your wait in the waiting room was before you were seen.
Did you wait too long in the waiting room?
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3
Please rate how clearly your preparations and risks of the tests were explained to you.
Were you prepared for the test?
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No
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4
Please rate the level of concern, care, respect, friendliness and kindness you were given.
Were our staff friendly?
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5
Please rate how clear the instructions you received were on what to do and what to expect after you have left the clinic.
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6
Please rate how likely you are to recommend this clinic to a friend or family member if they need the services of this clinic.
Would you recommend us to family and friends?
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7
How would you rate the services and the treatment you received at this clinic.
How would you judge the care you received at the clinic?
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8
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Full Name
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Alliston
Markham
Newmarket
Toronto
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Alliston
Markham
Newmarket
Toronto
Location
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Date Visited
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9
Please verify that you are human
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10
What suggestions or changes would you recommend to improve our service?
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