PATIENT SATISFACTION QUESTIONNAIRE

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First impressions

Convenience of appointment time   no comment/not applicable excellent very good good fair poor

Convenience of clinic location   no comment/not applicable excellent very good good fair poor

Greeting on arrival   no comment/not applicable excellent very good good fair poor

Help from consultant's secretaries   no comment/not applicable excellent very good good fair poor

Waiting area comfort and decor   no comment/not applicable excellent very good good fair poor

Overall first impression   no comment/not applicable excellent very good good fair poor

Amenities

Refreshments   no comment/not applicable excellent very good good fair poor

Papers/magazines   no comment/not applicable excellent very good good fair poor

Lavatory facilities   no comment/not applicable excellent very good good fair poor

Disables facilities   no comment/not applicable excellent very good good fair poor

General cleanliness   no comment/not applicable excellent very good good fair poor

Overall impression of amenities   no comment/not applicable excellent very good good fair poor

Consultant Care

Consultant's bed side manner   no comment/not applicable excellent very good good fair poor

Satisfaction with recommendations   no comment/not applicable excellent very good good fair poor

Satisfaction with queries answered   no comment/not applicable excellent very good good fair poor

Privacy (e.g. changing)   no comment/not applicable excellent very good good fair poor

Overall impression of care   no comment/not applicable excellent very good good fair poor

Overall assessment

Were you seen on time?   Yes No

Was you consultation long enough?   Yes No

Would you recommend your consultant to a friend?   Yes No

Would you recommend the clinic to a friend?   Yes No

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