Gynecological clinic evaluation questionnaire template

Hello,

Please take a few minutes of your time to fill in the following survey

1. Which method do you prefere to use to arange an appointment?

  • Telephone
  • In person
  • Email
  • Online booking through our website

2. Are you satisfied with booking an appointment in person at our office?

  • Yes

3. On avarage, how long do you have to wait to be examined?

  • 0-20 minut
  • 20-40 minut
  • 40-60 minut
  • 60+ minut

With an appointment

  • 0-20 minut
  • 20-40 minut
  • 40-60 minut
  • 60+ minut

Without an appointment

  • 0-20 minut
  • 20-40 minut
  • 40-60 minut
  • 60+ minut

4. How satisfied are you with our nurses?

5. Which of our Doctors last examined you?

  • Dr. 1
  • Dr. 2
  • Dr. 3

6. Please select the appropriate rating for your Doctor against the following statements:

Please mark 1, as exellent and 5, as the worst

  • 1
  • 2
  • 3
  • 4
  • 5

The Doctor acts professionaly at all times

  • 1
  • 2
  • 3
  • 4
  • 5

The Doctor is attentive and responds to my needs

  • 1
  • 2
  • 3
  • 4
  • 5

The Doctor is always discrete

  • 1
  • 2
  • 3
  • 4
  • 5

The Doctor is friendly and has a good manner

  • 1
  • 2
  • 3
  • 4
  • 5

The Doctor always provides me with all the information i need

  • 1
  • 2
  • 3
  • 4
  • 5

7. Does our Practice provide a sufficient ammount of privacy?

  • Yes

8. Are you satisfied with the medicines prescribed by our practice?

  • Very satisfied
  • Satisfied
  • Niether sadisfied nor dissatisfied
  • Dissatisfied
  • Very dissatisfied

9. Please state your age:

500

10. What could we change or do better next time? Please tell us in your own words:

500

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Gynecological Health patient satisfaction survey

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Strengthen your patients’ sense of trust and mental comfort. Offer them a gynecological clinic evaluation questionnaire template and ask for feedback.

Use template — it’s free

The survey sample is ideal for

  • managers of gynecological departments,
  • management of specialized clinics and facilities.

Use the evaluation questionnaire for this purpose, thanks to which you will get an overview of the overall level of your facility, as perceived by the female part of the population. What impression does the material background of the clinic make? Are patients satisfied with their attending physicians and staffing? Is there anything they would like to enjoy waiting for an examination? Does your ordering system work well? Ask these questions in the gynecological clinic evaluation questionnaire and look for opportunities for improvement.

The questionnaire template can be fully edited. Survio will process your answers into well-arranged tables and graphs.

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