Satisfaction assessment form after receiving service

1. Basic Information of the Client

Gender*
MaleFemaleOther

Age*

Email*

Date of Appointment*

Branch of Service*

Type of Service Received*

2. Satisfaction with the Service (Rate 1-5)

2.1 Staff and Service

Politeness and Reception of Staff:
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Clarity of Information or Advice:
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Staff's Care and Attention:
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2.2 Quality of Medical Services

Expertise and Credibility of the Doctor:
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Clarity in Explaining Diagnosis/Treatment:
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Timeliness of the Service (No Delays):
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2.3 Facilities

Cleanliness of the Premises:
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Comfort of the Waiting Area:
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Availability of Medical Equipment/Tools:
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3. Overall Satisfaction (Rate 1-5)

Overall Satisfaction with the Clinic's Service:
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Value for Money of the Service:
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Likelihood to Recommend Intouch Medicare Clinic to Others:
DefinitelyQuite LikelyMaybeUnlikelyNot at All

4. Feedback and Suggestions

Thank you for taking the time to provide your feedback. This information will help us improve our services further.