Post-Visit Survey — Maple Family Health Centre · ShaGha

Post-Visit Survey

Maple Family Health Centre

London, ON

Your feedback is completely optional and anonymous unless you provide your contact details. Takes about 2 minutes to complete.

Your Name

Email

Phone

How was our waiting room (cleanliness & comfort)?

1 — Very Poor

2 — Poor

3 — Average

4 — Good

5 — Excellent

How friendly and helpful was our staff?

1 — Very Poor

2 — Poor

3 — Average

4 — Good

5 — Excellent

How satisfied are you with the wait time?

1 — Very Poor

2 — Poor

3 — Average

4 — Good

5 — Excellent

Overall, how would you rate your experience?

1 — Very Poor

2 — Poor

3 — Average

4 — Good

5 — Excellent

How likely are you to recommend us? (1 = Not at all, 10 = Absolutely)

1 10 7

Additional Comments

Maximum 2,000 characters.

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