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OPHTHALMOLOGY SERVICE PATIENT FEEDBACK FORM

We would be grateful if you would complete this feedback form following your recent ophthalmology appointment. We aim to deliver complete patient satisfaction. Collecting and acting on our patient feedback is vital to our achieving this. Your opinions are therefore very valuable.

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* 1. How likely are you to recommend our clinic to friends or family if they needed similar care or treatment?

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* 2. Were you treated with courtesy throughout your appointment(s) by administration staff and the health professionals?

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* 3. Were you given clear explanation of your condition, any medication requirements, and your treatment?

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* 4. Were you involved as much as you wanted to be in decisions about your care and treatment?

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* 5. If you needed to ask any questions or discuss any concerns did you feel you were listened to?

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* 6. How would you rate your experience of using this service?

(On a scale of 1-5 with 1 being totally dissatisfied & 5 being excellent)

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* 7. Finally, we would be grateful for any of your own comments regarding the treatment you received, the service as a whole or any part of it

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* 8. Name of Doctor

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