Feedback Survey Form
  YOUR FEEDBACK IS VALUABLE TO US
  Welcome to Apollo Clinics feedback survey. We appreciate you taking the time to tell us about your visit. This information will be held in strictest confidence and only be used to improve your experience and our standard of care.
*Clinic :
*Name
*UHID
*Date of Visit
*Mobile Number
  EmailId
  1. Overall rating of the clinic
  a) How likely are you to refer Apollo Clinics to your friends, relatives or colleagues? Please rate the likelihood on a scale of 0 to 10 (10 being always and 0 being never)
Always Never
  b) Could you elaborate on the reason for high/low score?
  
  c) Will you consider this clinic as your regular source of care?
   How did you come to know about Apollo Medical Centre?
  2. Before reaching the clinic
  a) How would you rate the ease of getting an appointment?
Very Easy Easy Reasonably easy Difficult Very Difficult
  3. On reaching the clinic
  I. How would you rate the following?
  a) Cleanliness and ambience of the clinic:
Excellent Good Average Below average Poor
  b) Time taken at billing
Very quick Quick Reasonably quick Long Very Long
  c) Waiting time to see the doctor
Very quick Quick Reasonably quick Long Very Long
  d) Your experience with the doctor and explanation about the diagnosis, treatment, follow up and referrals.
Excellent Good Adequate Basic Inadequate
  4. Investigations and procedures
  a) How would you rate us on the ease of getting an appointment for investigations and procedures?
Very Easy Easy Reasonably easy Difficult Very Difficult
  b) How would you rate us on the waiting time for investigations and procedures?
Very Easy Easy Reasonably easy Long Very Long
  c) Were the reports ready at the committed time?
  5. Supporting clinical staff
  I. How would you rate the following on their courteousness?
  a) Nurses
Excellent Good Average Below average Discourteous
  b) Phlebotomist (blood collection)
Excellent Good Average Below average Discourteous
  c) Radiology technicians
Excellent Good Average Below average Discourteous
  II. How would you rate the following on their technical expertise?
  a) Nurses
Excellent Good Average Below average Inexperienced
  b) Phlebotomist (blood collection)
Excellent Good Average Below average Inexperienced
  c) Radiology technicians
Excellent Good Average Below average Inexperienced
  If there is anything else you would like to tell us about our service please do so here, or else feel free to leave this section blank:
  
Call to book appointment : 18605007788