Health Screening Guest Feedback

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Health Screening Guest Feedback

Location of Health Screening Centre

Do you wish to leave your contact details?

Yes

No

Name

Email

Phone Number

How did you hear about us?

Family/Friends

Company

Search Engine

Social Media

Website

Newspaper

Magazine

Others

Clinic Ambience

Clean and Tidy

Excellent

Good

Satisfactory

Poor

Comfortable

Excellent

Good

Satisfactory

Poor

Reception

Prompt in serving me

Excellent

Good

Satisfactory

Poor

Helpful and friendly

Excellent

Good

Satisfactory

Poor

Gave me clear instructions and answers

Excellent

Good

Satisfactory

Poor

Nursing

Prompt in serving me

Excellent

Good

Satisfactory

Poor

Show care and concern

Excellent

Good

Satisfactory

Poor

Gave me clear instructions and answers

Excellent

Good

Satisfactory

Poor

Doctor

Show care and concern

Excellent

Good

Satisfactory

Poor

Explained my condition clearly and gave good advice on treatment

Excellent

Good

Satisfactory

Poor

Post-Screening process

Prompt in serving me

Excellent

Good

Satisfactory

Poor

Provided clear information on follow-up procedures for health screening and/ or pending tests

Excellent

Good

Satisfactory

Poor

Other Feedback

How would you rate the refreshments (food and drinks) provided?

Excellent

Good

Satisfactory

Poor

What can we do to improve our refreshments?

How would you rate the overall service?

Much better than expected

Better than expected

As expected

Worse than expected

How would you rate the waiting time?

Prompt

Just right

Long but acceptable

Unacceptably long

Would you recommend this health screening centre to your friends and family?

Yes, I would strongly recommend

Yes, I would recommend

I may or may not recommend

No, I would not recommend

Do you wish to mention any staff for outstanding service?

Comments/Suggestions

Patient's Rights & Responsibilities

Do you understand your rights and responsibilities as a patient?

Yes

No

Consent

I consent that Healthway Medical doctors and healthcare personnel may collect, use and disclose my personal data to provide me with medical treatment and other related purposes in accordance with the Personal Data Protection Act 2012 and Healthway Medical Data Protection Policy.