Patient Connections

PatientConnections - Branded Experiences for Customers

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PatientConnections Feedback Form - Draft example

STEP 1 (The Practice) » STEP 2 (The Staff) » STEP 3 (The Dentist/Clinician)

THE PRACTICE

1- Please rank the following aspects of the service? (1 Poor) – (5 Excellent)

Are the general areas clean

1

2

3

4

5

Is the practice comfortable

1

2

3

4

5

Is there a friendly atmosphere

1

2

3

4

5

Is there sufficient literature/entertainment whilst you wait

1

2

3

4

5

Is there sufficient information about products and services

1

2

3

4

5

Are necessary sundry/health-care items available

1

2

3

4

5

2- How would you rate the practice? (1 Poor) – (5 Excellent)