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Surveys
2015
September
L
Lancet Customer
Lancet Customer
Nelspruit Customer Survey
0%
Exit Survey
Name: ________________________________
Contact No: ____________________________
Admin Staff: ________________________________
Nursing Staff: ______________________________
How welcome did you feel on entering Lancet?
Welcome
Not Welcome or Unwelcome
Unwelcome
How satisfied are you with our services?
Very Unsatisfied
Unsatisfied
Neutral
Satisfied
Very Satisfied
How friendly / helpful were the administration staff assisting you?
Poor
Average
Excellent
How friendly / helpful were the administration staff assisting you?
Very Unsatisfied
Unsatisfied
Neutral
Satisfied
Very Satisfied
How satisfied are you with our services?
Very Unsatisfied
Unsatisfied
Neutral
Satisfied
Very Satisfied
How friendly / helpful were the nursing staff assisting you?
Poor
Average
Excellent
Overall, how satisfied or dissatisfied are you with Lancet?
Completely unsatisfied
Somewhat unsatisfied
Neither satisfied nor unsatisfied
Somewhat satisfied
Completely satisfied
How likely are you to recommend Lancet to friends & family?
Not likely
Likely
Very Likely
Do you have any suggestions or comments?
______________________________________________
______________________________________________
______________________________________________
__________________________________________________________________________________________________
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