Surveys 2015 January Q QuestionPro Sample Survey

QuestionPro Sample Survey Customer Satisfaction Survey

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Exit Survey

Thank you for choosing asiamedical specialists | sportsperformance physiotherapy to serve your healthcare needs. We believe that our CARE for you must be Critical, Analytical, Resource appropriately and Effectively. To this end, we will be grateful for your time to complete this questionnaire to help us help you.       Is this your first visit ?   Yes   No       Did you make a prior / advance booking for this visit ?   Yes   No       Date of Consultation Month Day Year -- Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec   -- 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31   -- 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 2030 2031 2032 2033 2034 2035 2036 2037 2038 2039 2040 2041 2042 2043 2044 2045 2046 2047 2048 2049 2050 2051 2052 2053 2054 2055 2056 2057 2058 2059 2060 2061 2062 2063 2064 2065 2066 2067 2068 2069 2070 2071 2072 2073 2074 2075 2076 2077 2078 2079 2080 2081 2082 2083 2084 2085 2086 2087 2088 2089 2090 2091 2092 2093 2094 2095 2096 2097 2098 2099 2100 2101 2102 2103 2104 2105 2106 2107 2108 2109 2110 2111 2112 2113 2114 2115 2116 2117 2118 2119 2120 2121 2122 2123 2124 2125 2126 2127 2128 2129 2130 2131 2132 2133 2134 2135 2136 2137 2138 2139 2140 2141 2142 2143 2144 2145 2146 2147 2148 2149 2150 2151 2152 2153       Time of Consultation -- 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 -- Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec -- 2024 Hrs. Mins. AM/PM -- 01 02 03 04 05 06 07 08 09 10 11 12   -- 00 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59   AM PM       * Location   China Building (Central)   Ocean Centre (Tsimshatsui)   Gold Coast (Tuen Mun)       Please indicate by a tick how you feel about our overall service and our specific service areas and that of your attending professional(s) during your visit here.     Your satisfaction with our Overall Service: Excellent Good Acceptable Not Acceptable Totally Unacceptable       Your satisfaction with our Receptionist: Excellent Good Acceptable Not Acceptable Totally Unacceptable Not Applicable * Presentation * Courtesy * Attentiveness to your request * Efficiency * Treat you with dignity and respect * Provide you with clear information       * Is your attending professional a Doctor?   Yes   No     Your satisfaction with our Doctor: Excellent Good Acceptable Not Acceptable Totally Unacceptable Not Applicable Presentation Courtesy Attentiveness to your questions Thoroughness of examination Treat you with dignity and respect Provide you with clear advice / information Adequacy of consultation / treatment       * Is your attending professional a Nurse?   Yes   No     Your satisfaction with our Nurse: Excellent Good Acceptable Not Acceptable Totally Unacceptable Not Applicable Presentation Courtesy Attentiveness to your request Efficiency Treat you with dignity and respect Provide you with clear information       * Is your attending professional a Radiographer?   Yes   No     Your satisfaction with our Radiographer: Excellent Good Acceptable Not Acceptable Totally Unacceptable Not Applicable Presentation Courtesy Treat you with dignity and respect Provide you with clear information       * Is your attending professional a Physiotherapist?   Yes   No     Your satisfaction with our Physiotherapist: Excellent Good Acceptable Not Acceptable Totally Unacceptable Not Applicable Presentation Courtesy Attentiveness to your questions Thoroughness of examination Treat you with dignity and respect Provide you with clear advice / information Adequacy of consultation / treatment       Your satisfaction with our Environment:     Comfort Excellent Good Acceptable Not Acceptable Totally Unacceptable Not Applicable * Sitting Area * Consultation / Treatment * X-ray / MRI     Cleanliness Excellent Good Acceptable Not Acceptable Totally Unacceptable Not Applicable * Sitting Area * Consultation / Treatment * X-ray / MRI * Lavatory       Excellent Good Acceptable Not Acceptable Totally Unacceptable Not Applicable * Reading Materials * Refreshments     Your satisfaction with our Waiting Time Satisfaction Level[,] Time Waited Excellent Good Acceptable Not Acceptable Totally Unacceptable Not Applicable Consultation / Treatment X-ray / MRI Drug Dispensing Billing           Comments       If there are any specific areas in which you feel improvement is needed, please add your comments below?       Your responses will help us to improve our services.       Would you return for your future healthcare needs?   Yes   No       If No, why not?       Would you recommend our services to others?   Yes   No       If No, why not?       Please provide your details, if you wish to be contacted to address any concerns that you have.       First Name :  Surname :  Phone :  Email Address :        When is the Suitable Time to contact you?

Email: [email protected]    [email protected]    [email protected] www.asiamedicalspecialists.hk    www.marinamedical.hk    www.sp.hk