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Healthcare Quality and Service Survey
Dear Sir or Madam, please take a few minutes of your time to complete the following questionnaire.
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Healthcare Service Survey
1
How would you rate the quality of healthcare services provided?
Please select one option.
Excellent
Good
Average
Poor
2
Rate the overall service experience on a scale of 1 to 10.
Please rate from 1 being the lowest and 10 being the highest.
3
Share any additional feedback or suggestions.
Feel free to provide any comments or suggestions.
4
Were the healthcare facilities clean and well-maintained?
Please select one option.
Yes, very clean
Somewhat clean
Not clean
5
How satisfied were you with the communication from healthcare staff?
Please select one option.
Very satisfied
Satisfied
Neutral
Dissatisfied
6
Did you face any challenges in accessing healthcare services?
Please select one option.
Yes
No
7
Would you recommend our healthcare services to others?
Please select one option.
Definitely
Maybe
Not Sure
No
8
How responsive was the healthcare facility to your needs?
Please select one option.
Very responsive
Somewhat responsive
Not responsive
9
Please rate the cleanliness of the waiting areas.
Please rate from 1 being the lowest and 10 being the highest.
10
Any other comments or suggestions for improvement?
Feel free to provide any additional comments.
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