New Patient Questionnaire

Thank you for choosing 108 Harley Street. Your feedback helps us improve the care and service we provide. The questionnaire may be completed anonymously.

Date of Visit:

Consultant/Clinic:

Appointment Type:

Are you a:

How did you hear about us:

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Please Tick one response for each question. Where a question does not apply select N/A. (Excellent, Good, Neither, Unsatisfactory, Very Poor, N/A)

Appointments and Bookings:

How easy was it to arrange your appointment at a suitable date and time?

How would you rate the helpfulness and professionalism of the booking team?

How easy was it to contact us before your appointment?

How did you book your appointment?

Reception and Arrival

Reception and Arrival:

How would you rate the welcome you received on arrival?

How satisfied were you with the time you waited to be seen?

Were reception staff friendly, helpful and informative?

Consultant and Clinical Care:

How would you rate the care provided by your consultant or clinician?

Was information about your condition, investigation or treatment explained clearly?

Did you have enough opportunity to ask questions?

Nursing Care:

Were reception staff friendly, helpful and informative?

Results and Follow Up:

Accounts and Payment:

Facilities

Facilities:

Overall Experience:

Optional Contact Details:

Pay my Bill

Book an Appointment

Appointments and Bookings:

Reception and Arrival:

Consultant and Clinical Care:

Nursing Care:

Results and Follow Up:

Accounts and Payment:

Facilities:

Overall Experience:

Overall Experience Optional Contact Details:

Clinics

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New Patient Questionnaire

Appointments and Bookings:

Reception and Arrival:

Consultant and Clinical Care:

Nursing Care:

Results and Follow Up:

Accounts and Payment:

Facilities:

Overall Experience:

Overall Experience Optional Contact Details:

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