Patient Feedback Questionnaire

We would welcome your honest feedback so that we can continue to improve the services we provide. The responses to this questionnaire are anonymised so we will not be able to identify your responses personally. Please rate the following based on your experience:
PoorFairGoodVery GoodExcellent
1. My overall satisfaction with working with Dr Miller is:
2. The warmth of Dr Miller’s greeting to me was:
3. During my discussion with Dr Miller, please rate her ability to really listen to me:
4. Dr Miller’s explanations of things to me were:
5. The extent to which I felt reassured by Dr Miller was:
6. My confidence in Dr Miller’s ability is:
7. The opportunity Dr Miller gave me to express my concerns or fears was:
8. The respect shown to me by Dr Miller was:
9. The amount of time given to me for an appointment was:
10. Dr Miller’s consideration of my personal situation in deciding treatment or advising me was:
11. Dr Miller’s concern for me as a person during my appointment was:
12. The extent to which Dr Miller helped me to take care of myself was:
13. The recommendation I would give to my friends about Dr Miller would be:
Thank you for your time and assistance.

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