We are soliciting your opinion on the services provided at the Polyclinic. Your feedback is very important to us as it will help us to identify areas for improvement and increase patients’ satisfaction.

    Use the following scale to choose the most appropriate number for each statement:

    Department:

    How satisfied were you with the time it took to get an appointment?

    1. Poor2. Fair3. Good4. Very Good5. ExcellentN/A

    Were you adequately told by your physician how to prepare for your test?

    1. Poor2. Fair3. Good4. Very Good5. ExcellentN/A

    How was the courtesy and respect of our clinic staff?

    1. Poor2. Fair3. Good4. Very Good5. ExcellentN/A

    How was the cleanliness of the procedure room?

    1. Poor2. Fair3. Good4. Very Good5. ExcellentN/A

    Overall quality of care: how would you evaluate the services you received and the way you were treated?

    1. Poor2. Fair3. Good4. Very Good5. ExcellentN/A

    What do you feel can be done to further improve our services

    Any additional comments?

    In order to respond to any of the concerns you may have, please leave us your email address.