SurveyMonkey Powered Online Survey

1. About your visit to North Downs Specialist Referrals

Question Title

* 1. Date of visit:

The date to which the feedback refers:

Date

Question Title

* 2. Please tick the following on a scale - 5 (excellent) to 1 (poor)

	5 (excellent)	4	3	2	1 (poor)
First impressions	First impressions 5 (excellent)	First impressions 4	First impressions 3	First impressions 2	First impressions 1 (poor)
Telephone answering service	Telephone answering service 5 (excellent)	Telephone answering service 4	Telephone answering service 3	Telephone answering service 2	Telephone answering service 1 (poor)
Site facilities/parking	Site facilities/parking 5 (excellent)	Site facilities/parking 4	Site facilities/parking 3	Site facilities/parking 2	Site facilities/parking 1 (poor)
Service at reception	Service at reception 5 (excellent)	Service at reception 4	Service at reception 3	Service at reception 2	Service at reception 1 (poor)
Cleanliness of hospital	Cleanliness of hospital 5 (excellent)	Cleanliness of hospital 4	Cleanliness of hospital 3	Cleanliness of hospital 2	Cleanliness of hospital 1 (poor)
Appointment efficiency	Appointment efficiency 5 (excellent)	Appointment efficiency 4	Appointment efficiency 3	Appointment efficiency 2	Appointment efficiency 1 (poor)
Veterinary attention/communication	Veterinary attention/communication 5 (excellent)	Veterinary attention/communication 4	Veterinary attention/communication 3	Veterinary attention/communication 2	Veterinary attention/communication 1 (poor)
Friendliness/helpfulness of staff	Friendliness/helpfulness of staff 5 (excellent)	Friendliness/helpfulness of staff 4	Friendliness/helpfulness of staff 3	Friendliness/helpfulness of staff 2	Friendliness/helpfulness of staff 1 (poor)
Overall out-patient care	Overall out-patient care 5 (excellent)	Overall out-patient care 4	Overall out-patient care 3	Overall out-patient care 2	Overall out-patient care 1 (poor)
Overall in-patient care	Overall in-patient care 5 (excellent)	Overall in-patient care 4	Overall in-patient care 3	Overall in-patient care 2	Overall in-patient care 1 (poor)
Would you recommend us to a friend?	Would you recommend us to a friend? 5 (excellent)	Would you recommend us to a friend? 4	Would you recommend us to a friend? 3	Would you recommend us to a friend? 2	Would you recommend us to a friend? 1 (poor)