Screen Reader Mode Icon
We are constantly trying to improve patient care and as part of that we would like some feedback on your appointment. We would be very grateful if you would kindly fill in this completely anonymous questionnaire.

If you are filling this in for someone else, please answer the following questions from the patient's point of view.

Question Title

* 1. Please could you tell us who referred you to us?

Question Title

* 2. Are you filling in this questionnaire for:

Question Title

* 3. Which of the following best describes the reason you attended the clinic today? (Tick all that apply)

For questions 4-7, please consider your experience PRIOR to the appointment

Question Title

* 4. How easy was it to make an appointment?

Question Title

* 5. How satisfied were you with the appointment date/time offered?

Question Title

* 6. If you received a letter for your booking, how satisfied were you with the information given?

Question Title

* 7. How satisfied were you with the information provided ahead of your appointment?

For questions 8-17, please consider your experience AT your appointment

Question Title

* 8. How easy was it to find the department?

Question Title

* 9. Did staff make you feel welcome and at ease at your appointment?

Question Title

* 10. Were you seen promptly?

Question Title

* 11. How do you rate the information provided at your appointment?

Question Title

* 12. How do you rate the waiting area?

Question Title

* 13. How do you rate the production room?

Question Title

* 14. If you produced your sample at home, how would you rate the instructions given?

Question Title

* 15. How satisfied were you with the overall service you received in the fertility laboratory?

Question Title

* 16. Were you given the opportunity to ask questions during your appointment?

Question Title

* 17. Please add any other comments you want to make about the fertility laboratory:

Question Title

* 18. Please offer any suggestions for improvements that we can make to our service

Question Title

* 19. Overall, how do you rate our Fertility Laboratory Service?

Question Title

* 20. What was the date of your visit?

Date
The next questions will give us basic information about who took part in the survey. We will not use this information to identify you or the patient. If you are filling this in on behalf of the patient, please provide details about the patient.

Question Title

* 21. What is the age of the patient?

Question Title

* 22. What is the patient's ethnic group?

Question Title

* 23. What is the patient's ethnic group?

0 of 23 answered
 

T