Patient Feedback

Thank you for choosing 108 Harley Street. Your feedback helps us improve the care and service we provide.

You may submit this questionnaire anonymously. If you provide your contact details and consent to follow-up, your response will be identifiable.

Date of visit

Consultant or clinic

Appointment type

Consultation Test/Scan Procedure

Are you a…

New patient Returning patient

Please select one response for each rating question. Where a question does not apply, select N/A.

Did you have enough opportunity to ask questions?

Have you received your results or follow-up information?

Yes No Not yet due

Did you experience any problems with payment or insurance processing?

No Yes

If yes, please give details

What did we do well?

What could we improve, or is there anything else you would like us to know?

Optional: Leave these fields blank if you wish to remain anonymous.

Name

I am happy for a member of the team to contact me about my feedback.

Please avoid including detailed medical information in this feedback form. Contact the clinic directly if your message requires clinical advice.

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