Rate the information provided to you prior to your appointment at the clinic.

How was the promptness and efficiency of your appointment?

What is your feedback about the information give to your immediately after your appointment?

What do you think about the timeliness of the letter and prescription received by the doctor after your appointment?

Did you feel that the staff respected your privacy and dignity during your visit and appointment today?

Was there anything that you particularly LIKED? (please also share here if you thought any staff member was particularly helpful)

Was there anything that you particularly DISLIKED?

Full Name


Mobile Number

Patient ID