We are here to restore your smile.
Help us care for you better—please share your feedback or suggestions.
1. WHICH SERVICES DID YOU RECEIVE DURING YOUR VISIT TO LUTON HOSPITAL?
Rows
Inpatient
Outpatient
Services
2. HOW DID YOU KNOW ABOUT US?
*
WEBSITE
DOCTOR'S REFFERAL
INSTAGRAM
FRIENDS/ FAMILY
LINKED IN
BILLBOARD
FACEBOOK
OTHER MEDIA:RADIO/TV,ETC
3. KINDLY RATE YOUR OVERALL EXPERIENCE ON A SCALE OF 1 TO 5. (1 = Very Poor, 5 = Excellent)
*
Rows
1 – Very Disatisfied
2 – Dissatisfied
3– Somewhat Satisfied
4–Satisfied
5 – Very Satisfied
Experience
4. WE VALUE YOUR OPINION. KINDLY RATE YOUR EXPERIENCE WITH EACH DEPARTMENT YOU INTERACTED WITH.
Rows
Not Satisfied
Somewhat Satisfied
Satisfied
Very Satisfied
Customer Care
Radiology
Pharmacy
Billing
Dental
Optical
Doctors
Nurses
Laboratory
Security
Cleanliness & Sanitation
5. DID THE DOCTOR ADDRESS YOUR MAIN CONCERN TODAY?
*
Rows
STRONGLY AGREE
AGREE
NEUTRAL
DISAGREE
STRONGLY DISAGREE
THE DOCTOR UNDERSTOOD AND RESOLVED MY MEDICAL NEEDS
6. WOULD YOU REFER SOMEONE TO US?
*
YES
NO
NOT SURE
7. WHAT DID YOU LIKE MOST ABOUT YOUR VISIT, AND WHAT CAN WE IMPROVE ON?
8. MAY WE CONTACT YOU TO HELP US IMPROVE YOUR EXPERIENCE? Please share your phone number or email address.
Format: (000) 000-0000.
Submit
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