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Patient Satisfaction Survey
WFMP is interested in learning more about your opinion based on your last visit so we can improve our services and your experience as a patient. Please be aware that your responses are confidential and anonymous.
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During your last visit, what health care provider did you see?
*
Dr. Berry
Dr. Brand
Dr. de Wet
Dr. Hendriks
Dr. Lee
Dr. Luebbert
Dr. Schlenther
Dr. Stassen
Dr. van den Berg
Dr. van der Walt
Dr. Zulfigar
Cheryl Dechaine, RN
Lisa Childs, LPN
Other / Not Sure
During your last visit, what clinic did you attend?
Main Clinic
Same Day Care Clinic / Train Station
Clear selection
How would you rate the booking process at WFMP?
Very easy
Easy
Neutral
Difficult
Very difficult
Clear selection
Comments Regarding Booking Process:
Your answer
How did you book your appointment?
Phone
Online (via website)
Clear selection
How would you rate the politeness, courtesy and respect of the office staff?
Above average
Average
Neutral
Below average
Clear selection
Comments:
Your answer
How would you rate your visit with the health care provider that you saw today?
Very satisfied
Satisfied
Neutral
Dissatisfied
Very dissatisfied
Clear selection
Overall, how satisfied were you with your visit at WFMP?
Dissatisfied
1
2
3
4
5
Satisfied
Clear selection
Do you feel you are included in decisions made by your medical team?
Yes
No
Clear selection
Would you recommend WFMP to your family and friends?
Yes
No
Clear selection
Do you follow our videos and blog on our Facebook / Instagram?
Yes
No
Clear selection
Have you signed up for the patient portal, which allows for direct electronic communication between patient and doctor?
Yes
No
Clear selection
How can we improve our services at WFMP?
Your answer
Do you have any further comments or concerns?
Your answer
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