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CDC CUSTOMER SATISFACTION SURVEY
CUSTOMER SATISFACTION SURVEY
Personal Information
You are important to us. Please help us serve you better by taking a few minutes to express your satisfaction on our services rendered to you today.
Gender
*
Male
Female
Age
*
18 - 24
25 - 34
35 - 44
45 - 60
60+
Our Services
Reception
*
Excellent
Good
Average
Fair
Poor
Consultation
*
Excellent
Good
Average
Fair
Poor
Laboratory
*
Excellent
Good
Average
Fair
Poor
Pharmacy
*
Excellent
Good
Average
Fair
Poor
Dress Room
*
Excellent
Good
Average
Fair
Poor
Ward
*
Excellent
Good
Average
Fair
Poor
Facility Convenience
Clinic Hours
*
Excellent
Good
Average
Fair
Poor
Convenience of the facility
*
Excellent
Good
Average
Fair
Poor
Cleanliness of facility
*
Excellent
Good
Average
Fair
Poor
Waiting Time
*
Excellent
Good
Average
Fair
Poor
Comfort while Waiting
*
Excellent
Good
Average
Fair
Poor
Our Staff
Friendliness
*
Excellent
Good
Average
Fair
Poor
Knowledgeable and professionalism
*
Excellent
Good
Average
Fair
Poor
Respect
*
Excellent
Good
Average
Fair
Poor
Confidentiality respected
*
Excellent
Good
Average
Fair
Poor
Overall Impression
Overall, are you satisfied with the service today?
*
Yes
No
Willingness to return?
*
Yes
No
Likelihood of referring to another person?
*
Yes
No
Which service did you enjoy best?
*
Reception
Consultation
Consultation
Laboratory
Pharmacy
Dress Room
Ward
Which service did you enjoy best?
Reception
Consultation
Laboratory
Pharmacy
Dress Room
Ward
Suggestion
Contact You
How do you prefer to get information or questions answered
*
Phone
In Person
Written correspondence
Email
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