SURVEY FORM

Patient's Feedback on Our Services

Patient Satisfaction Survey

We would like to know how you feel about the services we provide so we can make sure we are meeting your needs. Your response is directly responsible for improving these services. All responses will be kept confidential and anonymous. Thank you for your time.

1. ABOUT YOU

Gender:
MaleFemale

Age:
0-1819-3435-5455-74

On what basis did you receive treatment?

CompanyPrivateHMOOthers( Specify)

Length of stay?
   


How did you hear or know about us?
Consultant ReferralPrevious VisitHMO Provider ListPersonal RecommendationLocationOthers( Specify)

2. YOUR SERVICE EXPERIENCE

Please indicate how well you think we are doing in the following areas:
Ratings: ( 4 --> Great, 3 --> Good, 2 --> Fair, 1 --> Poor )
ACCESSIBILITY TO HEALTHCARE:
Ease of scheduling appointments 4321
No of hours facility is open 4321
Convenience of Center’s location4321
Promptness in responding to phone calls4321
WAITING TIME:

Time in waiting room (Frontdesk)4321
Time waiting to see a doctor4321
Time waiting for tests to be performed4321
Time waiting for test results4321
STAFF:

Provider: (Medical doctor)
Listens to you 4321
Gives you good advice and treatment 4321
Friendly and helpful to you 4321
Inspired your confidence and trust 4321
Involved you in decisions regarding your care 4321
Nursing care: (Nurses)
Response to nurse call 4321
Dispensing medicines at the right time4321
Inspiring your confidence and trust 4321
Awareness and empathy towards your condition 4321
The way we managed your pain (do not answer if you were pain free) 4321
Professional Services:
Consultants 4321
Pharmacy 4321
Catering Services:
Promptness of catering service 4321
Quality of food 4321
Quality of service 4321
Variety/choice of food 4321
All Others:
Friendly and helpful to you 4321
Answer your questions intelligently 4321
FACILITY:
Neat and clean building 4321
Cleanliness of the toilet and bathrooms 4321
Entertainment in room 4321
Decor 4321
Care of visitors 4321
CONFIDENTIALITY:
Keeping my personal information private 4321
DISCHARGE PROTOCOLS AND PAYMENT:
Promptness of delivery of take home medication 4321
Explanation of payment procedure 4321
The likelihood of referring your friends and relatives to us 4321
Do you feel you got value for your money? 4321


3. AVON MEDICAL






Other helpful information:

Thank you for completing our survey and helping us improve.


OUR HMO CLIENTS

Instagram
Facebook