SATISFACTION QUESTIONNAIRE I would be grateful if you would help us to maintain the highest possible standards by kindly taking a few minutes to complete this questionnaire and please kindly return the completed form to me by the end of the week so that I may respond where necessary. Name Email Address City   EXCELLENT GOOD SATISFACTORY POOR Cleanliness of all Facilities Temperature and Comfort of Rooms Courtesy and Friendliness of Staff Privacy during Consultations Respect for your Dignity Staff Appearance Confidentiality in the Clinic / Written Reports Punctuality of Appointment Time Interaction with Doctor Provision of Information – service-- risks – benefits care -support - rights to make decisions Ease of booking an Appointment Timeliness of receiving your report / results           Were you fully informed about the fees for all services? Yes No     Did the service meet your individual needs? Yes No     Would you be interested in discussing this with me in person? Yes No               Do you have any suggestions or comments that would help us to improve our service? With grateful thanks : Nick Halsall - Business Manager

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