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Plastic / Cosmetic Surgery Clinic Assessment Survey
Dear Sir or Madam, please take a few minutes of your time to complete the following questionnaire.
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1
How satisfied are you with the cleanliness of our clinic?
Please rate the cleanliness of our clinic on a scale from 1 to 5.
2
Did you find our staff helpful and courteous?
Please choose the option that best describes your experience with our staff.
Very helpful and courteous
Somewhat helpful and courteous
Not helpful and courteous
3
How satisfied are you with the results of your procedure?
Please rate your satisfaction with the results of your procedure on a scale from 1 to 10.
4
Would you recommend our clinic to a friend or family member?
Please choose the option that best describes your likelihood to recommend our clinic.
Definitely yes
Maybe
Definitely not
5
How would you rate the overall experience at our clinic?
Please rate your overall experience at our clinic on a scale from 1 to 5.
6
What was the main reason for choosing our clinic for your procedure?
Please provide a brief explanation of the main reason why you chose our clinic.
7
Were you satisfied with the information provided to you before the procedure?
Please choose the option that best describes your satisfaction with the information provided.
Extremely satisfied
Satisfied
Not satisfied
8
How would you rate the level of communication with our medical staff?
Please rate the level of communication with our medical staff on a scale from 1 to 10.
9
Did you experience any complications after the procedure?
Please provide details if you experienced any complications after the procedure.
10
How likely are you to return to our clinic for future procedures?
Please choose the option that best describes your likelihood to return to our clinic.
Very likely
Maybe
Not likely
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