Patient Feedback Form
Thank you for your recent visit to MyHealth Centre.

Dear Patient:

Thank you for entrusting MyHealth Centre with your healthcare needs. It is our goal to deliver high-quality patient care using current clinical standards, appropriateness criteria and utilization that is consistent with the best practices.

To help serve you better, we would like your feedback on your recent visit. All responses will be kept confidential.

1) Please rate MyHealth Centre on the following:

a) Overall Facility:

b) Hours Open:

c) Privacy:

d) Location:

e) Cleanliness:

f) Waiting room:

g) Comfortable Layout:

h) Ease of booking:

i) Wait time:

j) Test preparation guidance:

2) Please rate the staff attending you:

a) Knowledgeable:

b) Gave Good Advice:

c) Friendly:

d) Answered my Questions:

e) Efficient in his/her work:

f) Gave me enough time:

g) Please provide the name of staff member who attended you:

3) Please provide your overall level of satisfaction:

My overall opinion of MyHealth Centre is:

4) Recommendation MyHealth Centre

Would you recommend MyHealth Centre to a friend or colleague?
YesNo

5) Other Comments

Please provide comments to help us improve service