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Post Consultation Feedback Questionnaire

Structured Survey for Service Improvement

Your feedback helps us improve our services and provide better care.

Section 1: General Experience

How satisfied were you with your consultation today? *

1 - Very dissatisfied2 - Dissatisfied3 - Neutral4 - Satisfied5 - Very satisfied

Did the consultant address your concerns adequately? *

1 - Not at all2 - Slightly3 - Moderately4 - Mostly5 - Completely

Was the consultation process easy to understand and follow? *

1 - Very difficult2 - Difficult3 - Neutral4 - Easy5 - Very easy

Were your questions answered clearly and professionally? *

1 - Not at all2 - Slightly3 - Moderately4 - Mostly5 - Completely

Section 2: Communication

How would you rate the communication skills of the consultant? *

1 - Very poor2 - Poor3 - Average4 - Good5 - Excellent

Did you feel comfortable discussing your issues or concerns? *

1 - Not at all comfortable2 - Slightly comfortable3 - Moderately comfortable4 - Mostly comfortable5 - Extremely comfortable

Was the information provided during the consultation clear and comprehensible? *

1 - Not clear at all2 - Slightly clear3 - Moderately clear4 - Mostly clear5 - Completely clear

Section 3: Timeliness and Convenience

Was your consultation scheduled at a convenient time for you? *

1 - Not at all convenient2 - Slightly convenient3 - Moderately convenient4 - Mostly convenient5 - Extremely convenient

Did the consultation start and end on time? *

1 - Not at all2 - Occasionally3 - Sometimes4 - Mostly5 - Always

Were you satisfied with the duration of the consultation? *

1 - Very dissatisfied2 - Dissatisfied3 - Neutral4 - Satisfied5 - Very satisfied

Section 4: Follow-up and Support

Were you informed about the next steps after the consultation? *

1 - Not at all2 - Slightly3 - Moderately4 - Mostly5 - Completely

Do you feel you have enough support or resources following the consultation? *

1 - Not at all2 - Slightly3 - Moderately4 - Mostly5 - Completely

Section 5: Suggestions for Improvement

Would you recommend our services to others? *

1 - Definitely not2 - Probably not3 - Not sure4 - Probably yes5 - Definitely yes

What could we do to improve our consultation services?

Consultation Date (Optional)

Your Email (Optional)

Thank You

We appreciate your input and will use your feedback to improve our services.

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Ngong Road, Applewood Adams
Nairobi, Kenya

0117 100 027 0733 503 766

info@clarividamedical.com

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Mon-Fri: 8:00 AM - 6:00 PM

Saturday: 9:00 AM - 1:00 PM

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