MPHC Feedback Form

Thank you for your visit to our clinic. We highly value your feedback as it is instrumental in our commitment to enhancing the quality of our services. Kindly take a few moments to complete the following form.

Personal Information (Optional)

Your Name

Date of Visit

Name of HCA you saw

Email Address

Phone Number

Appointment Process

How easy was it to schedule your appointment? Very EasyEasyNeutralDifficultVery Difficult

How would you rate the waiting time before seeing the HCA? Very ShortShortAcceptableLongVery Long

Clinic Environment

How would you rate the cleanliness of the clinic? Very CleanCleanNeutralSomewhat UncleanVery Unclean

How comfortable was the waiting area? Very ComfortableComfortableNeutralUncomfortableVery Uncomfortable

Staff Interaction

How courteous and helpful was the reception staff? Extremely CourteousCourteousNeutralSomewhat RudeVery Rude

How would you rate the professionalism of the HCA staff? ExcellentGoodNeutralPoorVery Poor

HCA Interaction

How would you rate the HCA explaining your condition and treatment options? ExcellentGoodNeutralPoorVery Poor

Did the HCA listen to your concerns and answer your questions? Yes CompletelyMostlySomewhatNot ReallyNot at All

Overall Experience

How would you rate your overall experience at our clinic? ExcellentGoodNeutralPoorVery Poor

Would you recommend our clinic to others? DefinitelyProbablyNot SureProbably NotDefinitely Not

Additional Comments

Please share any additional feedback or suggestions for improvement:

This feedback form can be distributed physically at the clinic, sent digitally via email, or integrated into an online survey platform. It’s essential to assure patients that their feedback is confidential and will be used to enhance their future experiences at the clinic.

CQC Registration: T70-H-000998271

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