Feedback Form
Thank you for completing this form. All complaints will be actioned within 24 hours. For urgent complaints, please contact us on 0408 993 259
Contact details of the person who is filling out the form
Name
First Name
Last Name
Email
example@example.com
Phone Number
Please state the full name of the participant if possible
Please choose one of the following options
General feedback
Complaint
Report amendment
Compliment
How long was the wait time between referral to appointment?
Short wait
Long wait
Same as expected
Was the nurse approachable?
Yes
No
Was the nurse professional?
Yes
No
Was the nurse knowledgeable?
Yes
No
Did the nurse provide the required information in a timely manner?
Yes
No
Do you have any feedback about the nurse?
Was the report appropriate?
Yes
No
Was the report professional?
Yes
No
Was the report easy to understand?
Yes
No
Was all the required information added to the report?
Yes
No
Do you have any feedback about the report?
Were all the products on the consumables quote appropriate?
Yes
No
Did you receive the consumables quote in a timely manner?
Yes
No
Do you have any feedback about the consumables?
Are you likely to choose Health N Home again if needed in the future?
Yes
No
Do you have any other comments or feedback?
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