PATIENT SATISFACTION SURVEY

Please take a few minutes to fill out this survey on the relevance and quality of service you have
received. BIRTHRIGHT INC. honors your feedback and your responses will be used to improve our
future performance. Thank you for your input.

Q1. On a scale of 0-10, considering your complete experience with our medical facility, how likely would
you be to recommend us to a friend or colleague?

0 1 2 3 4 5 6 7 8 9 10
Very Unlikely Very Likely

Q2. Please state your level of satisfaction with the process of booking an appointment with your doctor:
Very Satisfied
Satisfied
Neutral
Unsatisfied
Very Unsatisfied

Q3. Please rate your primary healthcare provider in:

Very Satisfied Satisfied Neutral Unsatisfied Very Unsatisfied

Conducting diagnosis
Prescribing medications

Q4. Are you currently covered under a health insurance plan?

Yes
No

Q5. When requesting an appointment, were you given a chance to see your primary provider?
Always
Sometimes
Never

Q6. How long did you have to wait (past the appointment time) to meet the doctor?
0-30 minutes
30-60 minutes
More than an hour
More than two hours

Q7. How satisfied were you with the following during your treatment at our medical facility?
Very Satisfied Satisfied Neutral Unsatisfied Very Unsatisfied

Professionalism of our staff

Hygiene at the Lying-in Clinic

Care provided by medical personnel

 Very Satisfied Satisfied Neutral Unsatisfied Very Unsatisfied

Time that a doctor spent with you

Attentiveness towards concerns

Co-ordination between different departments

Q8. Do you feel that our work hours are well suited to treat you?
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree

Q9. How convenient is our facility’s location for you?

Somewhat Convenient
Convenient
Neutral
Inconvenient

Q10. How would you rate us on the following parameters?

Very Good Good Average Poor Very Poor

Our concern for your privacy and

transparency

Quality of service received

Information provided towards leading a

healthier life

Q11. Do you know about all the healthcare services we offer?

I was told about all of them without asking
I was told after I asked for them
I was not told about them

Q12. How easy was it to get a follow-up appointment?

Very Difficult
Difficult
Neutral
Easy
Very Easy

Q25. Do you have any other feedback for us? ______________________________________

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