Clinicians Policy – Copy Strength Healthcare Patient Satisfaction Survey Patient Satisfaction SurveyPlease enable JavaScript in your browser to complete this form.Please tick one answer for each question and submit your feedback to our clinic administration. Dear Patient, we would be grateful if you would complete this questionnaire about your visit to the doctor today. Your feedback from this survey will enable us to identify areas that may need improvement. Your opinions are therefore very valuable. Please answer all the questions below. There are no right or wrong answers and your doctor will not be able to identify your responses. Thank YouDate and time of your appointmentDateTimeName of your Doctor / Clinician *Select the Doctor who who attended to youDr ADr BDr CDid this doctor make you feel relaxed and welcome? *No, not at allNo, not reallyYes, but not fullyYesYes, completelyDo you feel this doctor listened to you? *No, not at allNo, not reallyYes, but not fullyYesYes, completelyDid the doctor explain things to you in a way you could understand? *No, not at allNo, not reallyYes, but not fullyYesYes, completelyWere you involved as much as you wanted to be in decisions about your care and treatment? *Not ApplicableNo, not at allNo, not reallyYes, but not fullyYesYes, completelyDo you have confidence in the decisions made about your condition or treatment? *Not ApplicableNo, not at allNo, not reallyYes, but not fullyYesYes, completelyDo you know what will happen next with your care? *Not ApplicableNo, not at allNo, not reallyYes, but not fullyYesYes, completelyDo you know what to do if your condition gets worse? *Not ApplicableNo, not at allNo, not reallyYes, but not fullyYesYes, completelyDid the doctor treat you with respect and dignity? *No, not at allNo, not reallyYes, but not fullyYesYes, completelyDo you trust this doctor? *No, not at allNo, not reallyYes, but not fullyYesYes, completelyCommentsDo you have any specific comments about this doctor from this consultation?Submit
