top of page
360 Care Limited
Patient Feedback Form (Paper)
Appointment Date
Were you given clear preparation guidelines prior to you appointment ?
*
No
Yes
Was your appointment timely and did it suit you ?
*
No
Yes
Approximately how long were you kept waiting after your appointment time ?
*
0-5 Minutes
5-10 Minutes
10-15 Minutes
Over 15 Minutes
How would you rate this ?
*
Excellent
Very Good
Good
Fair
Poor
After your scan, were you informed as to how you would get your results ?
*
No
Yes
Select an option
*
Excellent
Very Good
Good
Fair
Poor
Comments
Submit
Feedback Form Submitted
bottom of page