Customer Feedback

Your feedback is valuable for us to improve

Name *

Visit Date *

City *

Clinics *

MR Number

1
a) How likely are you recommend Express Clinics to your friend, relatives or colleagues?
1 (Least Likely) 2 3 4 5 6 7 8 9 10 (Most Likely)
b) If your response is between 0-6, can you please specify the reason.....

2) How easy was it to get an appointment?
Very Satisfied Satisfied Neutral Unsatisfied Very Unsatisfied
Very Satisfied Satisfied Neutral Unsatisfied Very Unsatisfied

3) How easy was it to reach our Clinics?
Very Satisfied Satisfied Neutral Unsatisfied Very Unsatisfied
Very Satisfied Satisfied Neutral Unsatisfied Very Unsatisfied

4) Was the time taken for registration & billing upto your satisfaction?
Very Satisfied Satisfied Neutral Unsatisfied Very Unsatisfied
Very Satisfied Satisfied Neutral Unsatisfied Very Unsatisfied

5) Feedback on the staff
a) Were you satisfied by the courtesy and empathy shown by the team?
Very Satisfied Satisfied Neutral Unsatisfied Very Unsatisfied
Very Satisfied Satisfied Neutral Unsatisfied Very Unsatisfied
b) Were you satisfied with the Technical competence of the team?
Very Satisfied Satisfied Neutral Unsatisfied Very Unsatisfied
Very Satisfied Satisfied Neutral Unsatisfied Very Unsatisfied
c) Would you like recognize any particular member of the team?

6) How did you find the overall hygiene and ambience of the clinic?
Very Satisfied Satisfied Neutral Unsatisfied Very Unsatisfied
Very Satisfied Satisfied Neutral Unsatisfied Very Unsatisfied

7) Were the detailed steps of your check-up explained to you?
Very Satisfied Satisfied Neutral Unsatisfied Very Unsatisfied
Very Satisfied Satisfied Neutral Unsatisfied Very Unsatisfied

8) Has the estimated date & time of delivery of your reports been explained to you?
Yes No

9) What would be your preferred mode of contact in future?
Email Call SMS

10) Is there is anything else, you would like suggest or tell us about our services.....