VLDMC Patient Experience Survey

1

Patient's Name* This field is required.

First Name

Last Name

2

How satisfied are you with the overall care you received at our clinic?

Very Satisfied

Satisfied

Dissatisfied

Very Dissatisfied

4

How would you rate the friendliness and professionalism of our staff?* This field is required.Choose options from Poor, Fair, Good, or Excellent by using the slider.

5

Did you feel respected and valued as a patient?* This field is required.

YESNO

6

Did you feel that your concerns were listened to and addressed by the healthcare providers?* This field is required.

Yes, always

Most of the time

Sometimes

Rarely

Never

7

How would you rate the cleanliness and comfort of our facilities?* This field is required.

Very Clean and Comfortable

Clean and Comfortable

Needs Improvement

Poor

9

Would you recommend our clinic to family and friends?* This field is required.

Definitely Yes

Probably Yes

Probably No

Definitely No

10

Please share any suggestions for improvement or comments about your experience at our clinic?* This field is required.

11

Your smile means the world to us! 💖 If we’ve brought joy to your day, please share the love by leaving us a 5-star review on Google before clicking on the Submit button. Just scan or click the QR code below. We truly appreciate you! A big thanks in advance! 😊