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NCTC Patient Satisfaction Survey
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How were your interactions with the doctor and office staff?
Your answer
What is your age?
Your answer
What is your gender
Male
Female
Clear selection
What is your diagnosis
Your answer
Date of admission
MM
/
DD
/
YYYY
Date of discharge
MM
/
DD
/
YYYY
How long did wait at the Centre
between 30 mins to 1 hour
between 1 hour to 2 hours
between 2 hours to 3 hours
between 3 hours to 4 hours
between 4 hours to 5 hours
Clear selection
After your vitals were taken, how long did it take you to see the doctor?
Between 0 to 30 mins
Between 30 mins to 1 hour
Between 1 hour to 2 hours
Between 2 hours to 3 hours
Between 3 hours to 4 hours
Clear selection
Did you do inr test?
Yes
No
Clear selection
How was the wait time?
Your answer
Did you get enough time with the doctor?
Yes
No
Clear selection
How easy was it to schedule an appointment?
1
2
3
4
5
Clear selection
What else do you want us to know?
Your answer
How was your interaction
Not satisfied
1
2
3
4
5
Very Satisfied
Clear selection
How was the laboratory services
Not satisfied
1
2
3
4
5
Very satisfied
Clear selection
Overall how satisfied were you with the service delivery at the OPD
Not satisfied
1
2
3
4
5
Very satisfied
Clear selection
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