ASHLEY & MARTIN PATIENT'S CENTRE

ASHLEY & MARTIN PATIENT'S CENTRE

FOUR MONTH PATIENT SURVEY

Thank you for attending your four month checkup, we would appreciate your feedback on your experience with Ashley and Martin by filling in this short survey.

Unique ID
Your Clinic*
Have you found your treatment manageable?*
- Yes
- No
How much time per day do you spend on using your medications?*
- 2 Min
- 5 Min
- 10 Min
Please rate your experience with the front office reception team*
- 5 (Very Satisfied)
- 4 (Satisfied)
- 3 (OK)
- 2 (Dissatisfied)
- 1 (Very Dissatisfied)
Do you have any comments on your experience with the reception team?
Please rate your experience with your consultant*
- 5 (Very Satisfied)
- 4 (Satisfied)
- 3 (OK)
- 2 (Dissatisfied)
- 1 (Very Dissatisfied)
Do you have any comments on your experience with your consultant?
Please rate your experience with the doctor*
- 5 (Very Satisfied)
- 4 (Satisfied)
- 3 (OK)
- 2 (Dissatisfied)
- 1 (Very Dissatisfied)
Do you have any comments on your experience with the doctor?
Did you have your 4 month progress photos taken and did you view the comparison with your initial photos?*
- Yes
- No
How satisfied are you with the results so far?*
- 5 (Very Satisfied)
- 4 (Satisfied)
- 3 (OK)
- 2 (Dissatisfied)
- 1 (Very Dissatisfied)
Did your consultant suggest posting a Google review about your experience so far?*
- Yes
- No
Do you have any other comments?