Patient satisfaction assessment form

Dear patients,
In accordance with the quality policy of the Provita Diagnostic and Treatment Center, improving our services is an absolute priority. Our priority is to fully meet your demands and expectations. Please take a few minutes to fill out this form. Your responses will help us improve the quality of our services.
Thank you!
Questions marked with * are required.


Medical services requested at the following clinic: *

1. How did you find out about Provita? *

2. How easy did you get in touch with us? *

On a scale from 1 to 10, where 1 is “highly dissatisfied” and 10 is “very satisfied”, please note our questions.

3. How satisfied are you with our communication? *

4.How satisfied are you with the quality of our services? *

5. How satisfied are you with the price of our services? *

6. How satisfied are you with communicating with the front-desk staff? *

7. How satisfied are you with the services offered by our assistants? *

8. How satisfied are you with the services offered by our doctors? *

9. How satisfied are you with the hygiene and ambience of the clinic? *

10. Considering Provita's performance: *

YES NO
Do you want to continue working with us?
Would you recommend us to a friend, acquaintance, relatives?
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