Dr Ito Clinic

questionnaire

- your opinions make a difference! -
Dr Ito would like to offer you the opportunity to provide feedback to assist us in our efforts to continually improve on Dr Ito Clinic services.Your information will be kept confidential and you will only be contacted if you desire Dr Ito to do so.
"Thank you for taking the time to fill out this questionnaire and allowing Dr Ito the opportunity to serve you better"
Please put a password in the box, if you have.
Please put oooo in the box, if you don't have.
Thanks for your cooperation.
Please fill in the form below to send me an email.

Password: *

Your Name:

Your Email:

About Dr Ito Clinic Service: (1)How easy was it to find Dr Ito Clinic *
Very easy
Fairly easy
Fery difficult

(2)How helpful do you find the receptionists at Dr Ito Clinic? *
Very helpful
Fairly helpful
Not very helpful
Not at all helpful

(3)In the reception area and the waiting room, can other patients overhear what you say? *
Yes, but I don't mind
Yes, and I am not happy about it
No, other patients can't overhear

(4)How clean is Dr Ito Clinic *
Very clean
Fairly clean
Not very clean
Not at all clean

Getting through on the phone.How easy have you found the following?: (1)Getting through on the phone *
Haven't tried
Very easy
Fairly easy
Not very easy
Not at all easy

(2)Speaking to a doctor on the phone *
Haven't tried
Very easy
Fairly easy
Not very easy
Not at all easy

(3)Speaking to a staff on the phone *
Haven't tried
Very easy
Fairly easy
Not very easy
Not at all easy

(4)Getting test results on the phone *
Haven't tried
Very easy
Fairly easy
Not very easy
Not at all easy

Waiting time at Dr Ito Clinic:How do you feel about how long you normally have to wait? *
I don't normally have to wait too long
I have to wait a bit too long
I have to wait far too long

Opening hours:How satisfied are you with the hours that Dr Ito Clinic is open? *
Very satisfied
Fairly satisfied
Fairy dissatisfied
Very dissatisfied
I'm not sure when Dr Ito Clinic is open

What time would you like Dr Ito Clinic to open at additional times? If any.

How good was Dr Ito at each of the following? (1)Giving you enough time *
Very good
Good
Good/Poor
Poor
Very poor

(2)Asking about your symptoms *
Very good
Good
Good/Poor
Poor
Very poor

(3)Listening to you *
Very good
Good
Good/Poor
Poor
Very poor

(4)Explaining tests and treatments *
Very good
Good
Good/Poor
Poor
Very poor

(5)Involving you in decisions about your care *
Very good
Good
Good/Poor
Poor
Very poor

(6)Treating you with care and concern *
Very good
Good
Good/Poor
Poor
Very poor

(7)Taking your problems seriously *
Very good
Good
Good/Poor
Poor
Very poor

Your overall satisfaction *
Very satisfied
Fairly satisfied
Neither satisfied nor dissatisfied
Fairy dissatisfied
Very dissatisfied

Out of hours care:(1)If you wanted to, would you know how to contact an out of hours Dr Ito Clinic Service when it is closed? *
Yes
No

(2)Have you tried to call an out-of-hours Dr Ito Clinic service when the clinic was closed? *
Yes
No

(3)How easy was it to contact the out-of-hours Dr Ito Clinic by phone *
Very easy
Fairly easy
Not very easy
Not at all easy
don't know/didn't make contact

(4)How do you feel about how quickly you received from the out-of-hours Dr Ito Clinic service? *
Very good
Good
Neither good nor poor
Poor
Very poor
Don't know/doesn't apply

Do you have any requests to Dr Ito or Dr Ito Clinic services?

Thank you very much for your cooperation.