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  1. Surveys
  2. 2012
  3. August
  4. P
  5. Patient Satisfaction Survey
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Dear Midwest College of Oriental Medicine Patient:
You are invited to participate in our Patient Satisfaction Survey. In this survey, approximately 500 people will be asked to complete a survey that asks questions about their experience in our clinic. It will take approximately 5 minutes to complete the questionnaire.

Your participation in this study is completely voluntary. There are no foreseeable risks associated with this project. However, if you feel uncomfortable answering any questions, you can withdraw from the survey at any point. It is very important for us to learn your opinions.

Your survey responses will be strictly confidential and data from this research will be reported only in the aggregate. Your information will be coded and will remain confidential. If you have questions at any time about the survey or the procedures, you may contact Midwest College of Oriental Medicine at 262-554-2010 or by emailing [email protected]

Thank you very much for your time and support. Please start with the survey now by clicking on the Continue button below.

 
 
 
 
Is this your first visit?
 
Yes
 
No
 
 
 
If not, how many treatments have you had?
 
1
 
2
 
3
 
4
 
More than 4

 
 
 
How professional was the Intern?
 
Very Professional
 
Professional
 
Somewhat Professional
 
Unprofessional

 
 
 
Was the Supervisor present during any part of your visit?
 
Yes
 
No

 
 
 
Would you refer your family, friends or neighbors to this clinic?
 
Yes
 
No

 
 
 
Comments/Suggestions:
   
 
Thank you for participating in our Patient Satisfaction Survey! Your responses are important and assist us in creating a better patient experiences in the future.
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