Lancet Customer

Name: ________________________________

Contact No: ____________________________

Admin Staff: ________________________________

Nursing Staff: ______________________________

How welcome did you feel on entering Lancet?

Welcome

Not Welcome or Unwelcome

Unwelcome

How satisfied are you with our services?

How friendly / helpful were the administration staff assisting you?

Poor

Average

Excellent

How friendly / helpful were the administration staff assisting you?

How satisfied are you with our services?

How friendly / helpful were the nursing staff assisting you?

Poor

Average

Excellent

Overall, how satisfied or dissatisfied are you with Lancet?

Completely unsatisfied

Somewhat unsatisfied

Neither satisfied nor unsatisfied

Somewhat satisfied

Completely satisfied

How likely are you to recommend Lancet to friends & family?

Not likely

Likely

Very Likely

Do you have any suggestions or comments?

______________________________________________

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