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Patient Feedback Questionnaire

Patient Feedback Questionnaire

In order to provide you with the best treatment and care possible, we want to know how well we are doing now and what we might do better from your point of view. We would be grateful if you could take a couple of minutes to provide us with information to assist us in our effort to better serve you.

Q1: Are you the patient?
Yes
No, I am completing on behalf of the patient 

Q2: Thinking about how caring the medical team that attended to you, were you?
Very Satisfied
Satisfied
Neither Satisfied nor Dissatisfied
Dissatisfied
Very Dissatisfied
Don’t Know / Can’t Say
Not Applicable

Q3: How satisfied were you with the standard of treatment provided, were you?
Very Satisfied
Satisfied
Neither Satisfied nor Dissatisfied
Dissatisfied
Very Dissatisfied
Don’t Know / Can’t Say
Not Applicable

Q4: How satisfied were you with the medical teams’ explanation about what was happening to you and why, were you?
Very Satisfied
Satisfied
Neither Satisfied nor Dissatisfied
Dissatisfied
Very Dissatisfied
Don’t Know / Can’t Say
Not Applicable

Q5: How satisfied were you overall with your experience using MedAid Services?
Very Satisfied
Satisfied
Neither Satisfied nor Dissatisfied
Dissatisfied
Very Dissatisfied
Don’t Know / Can’t Say
Not Applicable

Q6: Were the medical team dressed smartly and appropriately?
Yes
No

Q7: Were the medical team clearly identifiable?
Yes
No

Q8: Did you feel you were given the appropriate amount of privacy?
Yes
No

Q9: Gender (of the patient):
Male
Female

Q10: Age group (of the patient):
0-5
6-18
19-25
26-65
65 and over

Q11: Please add any additional comments you have regarding your experience with MedAid Services:

MedAid Services respects your privacy and would like to thank you for taking the time to complete this questionnaire.