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EUROMEDIC PATIENT’S SATISFACTION SURVEY
FOR PATIENTS WHO RECEIVED CCSVI “LIBERATION”TREATMENT AT EUROMEDIC CLINIC
Dear Sir or Madam
We would like you to devote a moment of your time to the EuroMedic Survey.
The goal of our survey is to learn your opinion concerning the quality of EuroMedic’s medical and administrative services The information you will provide us with, will allow us to enhance our services, address your concerns and better meet your expectations! Your feedback is invaluable, it will give us a chance to find out our deficiencies and allow us to implement all the recommended by you alteration.
Please fill out the survey below by selecting a response consistent with your experience, then rate the services you received while visiting our Clinic.
A separate space is provided for your comments.
This survey should only take about 10 minutes of your time.
Thank you for your time and participation!
Step 1/9
EUROMEDIC PATIENT’S SATISFACTION SURVEY
PERSONAL INFORMATION:
Name
*
Email address
*
Age
*
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Gender
*
Female
Male
Where did you hear about the Euromedic Clinic?
*
Web page www.euromedicpoland.com
Other Internet websites
Friends
TV
Other
If you select Other in the options above please enter your answer here
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Step 2/9
I. Material usefulness assessment: (please fill the chart using the scale):
Web page www.euromedic.com
Was the Information useful?
*
Definitely yes
Yes
I do not know
No
Not at all
Was the Information complete?
*
Definitely yes
Yes
I do not know
No
Not at all
Was the Information presented in a clear manner?
*
Definitely yes
Yes
I do not know
No
Not at all
Facebook
Was the Information useful?
*
Definitely yes
Yes
I do not know
No
Not at all
Was the Information complete?
*
Definitely yes
Yes
I do not know
No
Not at all
Was the Information presented in a clear manner?
*
Definitely yes
Yes
I do not know
No
Not at all
E-mail messages
Was the Information useful?
*
Definitely yes
Yes
I do not know
No
Not at all
Was the Information complete?
*
Definitely yes
Yes
I do not know
No
Not at all
Was the Information presented in a clear manner?
*
Definitely yes
Yes
I do not know
No
Not at all
Printouts
Was the Information useful?
*
Definitely yes
Yes
I do not know
No
Not at all
Was the Information complete?
*
Definitely yes
Yes
I do not know
No
Not at all
Was the Information presented in a clear manner?
*
Definitely yes
Yes
I do not know
No
Not at all
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Step 3/9
II. EVALUATION OF PATIENT’S OFFICE COORDINATORS PERFORMANCE:
1. How would you evaluate the level of telephone skills (clarity of supplied information, language sufficiency?)
*
Excellent
Good
Have no opinion
Unsatisfactory
Very unsatisfactory
2. How would you evaluate the proficiency of the service? (Service’s level and speed)
*
Excellent
Good
Have no opinion
Unsatisfactory
Very unsatisfactory
3. How would you evaluate the completeness of the supplied information?
*
Excellent
Good
Have no opinion
Unsatisfactory
Very unsatisfactory
4. As Patient’s Office Coordinators how we can improve our work to enhance our services and address your concerns.(Write your comment please)
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Step 4/9
III. Assessment of Ambulance Care Assistant’s work:
*This should be filled only by patients who used Euromedi’s transport services, if you did not, please continue to the next question.
Drivers’ name
Piotr Chorąży
Krzysztof Kwosek
Maciej Gołębiewski
Marek Chorąży
Your driver/check the right box
Please select your driver:
1. How would you rate the level of transportation services provided by EuroMedic? (Punctuality, concentration, efficiency, safety, driving speed level, neatness of the vehicle and driver,)
Excellent
Good
Have no opinion
Unsatisfactory
Very unsatisfactory
2. How would you evaluate the Ambulance Care Assistant (ACA) English language communication skills, comprehension, listening and conversational capabilities?
Excellent
Good
Have no opinion
Unsatisfactory
Very unsatisfactory
3. How would you evaluate the Ambulance Care Assistant (ACA) conduct, friendly, kind, accommodating supportive with caring luggage, wheelchairs.
Excellent
Good
Have no opinion
Unsatisfactory
Very unsatisfactory
4. What kind of suggestion do you have to improve work of Ambulance Care Assistant (ACA) to better satisfy your needs? Please write your comments below.
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Step 5/9
IV. Evaluation of the quality of the hotel services you stayed at:
* This should be filled in by patients who were using accommodation offered by Euromedic. If you did not use this service, please go to the next question
1. Which hotel did you stay at?
Hotel Qubus
Hotel Angelo
Inne
2. How would you evaluate the quality of service of the hotel you stayed at? (Dealing well with people and be able to vary approach depending on the guest, tactful, courteous, responsive, helping solving problems, room service quality)
Excellent
Good
Have no opinion
Unsatisfactory
Very unsatisfactory
3. How would you evaluate the condition of the room you stayed in? (Furnishing, equipment, cleanness)
Excellent
Good
Have no opinion
Unsatisfactory
Very unsatisfactory
4. How would you evaluate the taste and the quality of food served?
Excellent
Good
Have no opinion
Unsatisfactory
Very unsatisfactory
5. If you have any suggestion regarding the hotel you stayed at, please write your comments below:
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Step 6/9
V. Assessment of the Euromedic Hospital:
1. How would you evaluate the level of patient’s care?
*
Excellent
Good
Have no opinion
Unsatisfactory
Very unsatisfactory
2. How would you evaluate the Euromedic Clinic level of service (general comfort, wheelchair accessibility, the admission process, treatment, conduct of staff, discharge of patients)
*
Excellent
Good
Have no opinion
Unsatisfactory
Very unsatisfactory
3. What are your suggestions and/or expectations regarding Euromedic Clinic? Please write your comments below
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Step 7/9
VI. Assessment of the healthcare level:
1. During hospital stay, did the doctor explain in details your procedure in a way you could understand it?
*
Definitely yes
Yes
I do not know
No
Not at all
2. How would you evaluate doctor's approach to you as a patient? (kind, compassionate perceptive thoughtful)
*
Excellent
Good
Have no opinion
Unsatisfactory
Very unsatisfactory
3. What are your suggestions and/or expectations regarding the medical healthcare at EuroMedic Clinic? Please write your comments below
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Step 8/9
VII. Assessment of the healthcare level:
1. How would you evaluate the level of care of nurses’ staff?
*
Excellent
Good
Have no opinion
Unsatisfactory
Very unsatisfactory
2. How would you evaluate the nurses’ approach to you as a patient? (carring, kind, understanding, helping, supportive, concerned)
*
Excellent
Good
Have no opinion
Unsatisfactory
Very unsatisfactory
3. What are your suggestions and/or expectations regarding the work of the nurses’ staff? Please write your comments below.
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Step 9/9
VIII. General assessment of Euromedic clinic:
1. Why did you choose EuroMedic for your CCSVI procedure? Please write your comments below.
*
2. Are you satisfied with your choice of the Euromedic Clinic?
*
Definitely yes
Yes
I do not know
No
Not at all
3. Would you recommend EuroMedic to your relatives, friends, people you know?
*
Definitely yes
Yes
I do not know
No
Not at all
4. General assessment of Euromedic clinic:
*
Excellent
Good
Have no opinion
Unsatisfactory
Very unsatisfactory
5. Do you have any comments/questions which the survey doesn't include?
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