Patient Satisfaction Survey

Patient Feedback

We value your feedback to assist us to improve the service that we provide to our patients

We ask for your help by completing this short 11 question survey relating to your recent treatment. We welcome your additional comments.

Information regarding the collection of your data: Snapforms has developed a comprehensive set of practices and technologies to help ensure the reliability, security and protection of our systems and your data. To meet Australian privacy legislation all data is stored in Australia, and snapforms adhere to the Australian Privacy Principles. You can read more about this on snapforms security page. By completing this form you agree to the use of snapforms for the collection of this information. If you wish to complete these forms via pdf copy instead please email us directly.

Was communication clear and did you feel included in the decision making for your procedure / care when applicable? *

Strongly agreeAgreeUnsureDisagree

Did you feel your privacy was respected? *

Yes, at all timesSometimes Not at all

Was the time you waited for your procedure.. *

Good Fair Needs improvement

Did you receive Informed Financial consent on the day of your procedure? *

Yes No I am unsure

How would you rate the refreshments /snacks provided post procedure? *

Good Fair Needs improvement

How would you rate the noise level *

Quiet Fair Too Noisy

How would you rate the cleanliness of the environment? *

Very Clean Fair Needs improvement

What are we doing well?

What could we do better?

Name (Optional) / would like to be contacted regarding your feedback?