Aesthetic/plastic surgery clinic evaluation questionnaire template

Hello,

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

1. How did you hear about our clinic?

  • Advertising
  • The internet
  • A recommendation
  • Television

2. How do you prefer to book appointments for medical examinations?

  • In person
  • Over the Telephone
  • Via Email
  • Via the Clinic's website

3. Did you have any issues when trying to make an appointment?

  • No

4. Please rate our staff against the following statments:

Please mark, 1 - excellent, 5 - Worst

  • 1
  • 2
  • 3
  • 4
  • 5

The front desk staff were friendly and helpfull

  • 1
  • 2
  • 3
  • 4
  • 5

Our nurses and porters were always well groomed and acted with care and professionalism

  • 1
  • 2
  • 3
  • 4
  • 5

The Doctor displayed expertise and answered all my questions

  • 1
  • 2
  • 3
  • 4
  • 5

The Doctor was friendly and had a good bedside manner

  • 1
  • 2
  • 3
  • 4
  • 5

The Doctor always provided me with all relevant and important information

  • 1
  • 2
  • 3
  • 4
  • 5

Communication with the staff was easy and i found them helpfull

  • 1
  • 2
  • 3
  • 4
  • 5

5. How would you rate the equipment and facilities provided at our clinic?

6. What surgery type did you have?

  • Choose...
    • Choose...
    • Remodeling of the eyelids
    • Liposuction
    • Breast enlargment/reduction
    • Shaping of the buttocks
    • Mole/birthmark removal
    • Rhinoplasty (nose)
    • Oral fulfillment (lips)

7. Are you satisfied with the results of the procedure?

  • Yes

8. Please rate your satisfaction with our prices?

9. Would you recommend us to a friend or collegue?

  • Yes

10. Please confirm your gender:

  • Male
  • Female

11. Please confirm your age:

12. Would you change anything about our clinic or services?

500

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Plastic / Cosmetic Surgery clinic assessment survey

Popularity 175 ×

Client satisfaction with the stay and procedure results will bring positive responses. Use a clinic evaluation questionnaire template to gather suggestions.

Use template — it’s free

The survey sample is ideal for

  • owners and management of plastic and aesthetic surgery clinics,
  • doctors in specialized departments.

The answers from the evaluation survey will enable the representatives of plastic and aesthetic surgery centers to objectively assess the background and activities of their institutions and focus on specific areas that require procedural or personnel change leading to an overall improvement of the services offered. Share the results with the attending physicians of the individual departments, consult on the need for new equipment, behavior towards patients, and work to increase the standards of the care provided.

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

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