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Evaluation

Please Fill The Form Below For Evaluation

In orden to find out how we are meeting your needs,we are asking our patients a few questions about the care they have received in order to make our service to you and your family even better.Thank you for your comments.

AGE

18-25 26-40 41-55 OVER 55

HOW WERE YOU REFERRED TO OUR PRACTICE?

FRIEND/FAMILY MEMBER DOCTOR REFERRAL OFFERS AND ADVERTISEMENT INTERNET

GENDER

MALE FEMALE

THE NUMBER OF VISITS TO THE OFFICE IN THE PAST YEAR IS :

1 2 3 4 5 MORE

NAME OF THE DOCTOR WHO TREATED YOU:

YOUR FULL NAME

YOUR MOBILE NUMBER

1- THE FACILITY WAS NEAT AND CLEAN

EXCELLENT VERY GOOD ACCEPTABLE POOR

COMMENTS:

2-THE RECEPTION STAFF WAS PROFESSIONAL AND COURTEOUS

EXCELLENT VERY GOOD ACCEPTABLE POOR

COMMENTS:

3-THE D0CTOR WAS PROFESSIONAL AND COURTEOUS AND EXPLAINED MY CASE AND TREATMENT OPTIONS

EXCELLENT VERY GOOD ACCEPTABLE POOR

COMMENTS:

4-THE QUALITY OF SERVICE YOU RECEIVED

EXCELLENT VERY GOOD ACCEPTABLE POOR

COMMENTS:

5- IT WAS EASY TO MAKE MY APPOINTMENT AND THE APPOINTMENT SECRETARY WAS POLIT AND HELPFUL

EXCELLENT VERY GOOD ACCEPTABLE POOR

COMMENTS:

WHAT L LIKED BEST ABOUT THE OFFICE WAS:

IN WHAT WAY(S)COULD WE HAVE MADE YOUR EXPERIENCE BETTER?

WOULD YOU RECOMMEND OUR OFFICE TO FAMILY MEMBER OR FRIEND?

YES NO

(All the fields with '*' are mandatory)

CONTACTS

Phone

Mobile: 0502055577
Tel : 920001155

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