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1. Contact Information
First Name : 
Last Name : 
Email Address : 
 
 
 
2. How would you rate the medical expertise of Hospitals in U.A.E.? (select one)
 
Excellent (5)
 
Good (4)
 
Average (3)
 
Poor (2)
 
Very Poor(1)
 
 
 
3. Do you prefer to consult a Clinic? or a Hospital?(select one)
 
Clinic
 
Hospital

 
 
 
4. Name of the hospital / clinic you visit?
   
 
 
 
5. Your reason for choosing a hospital / clinic? (select many)
 
Friends/ Family Advice
 
Doctor’s Advice
 
Insurance
 
Hospital Reputation
 
Cost Factor
 
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Location

 
 
 
6. What is the most important factor that affects your selection of a doctor/ clinic/ hospital? (select one)
 
Clinical Expertise
 
Looks/ Grooming of the Doctor
 
International Degree
 
Location
 
Vast Experience
 
Friends/ Family Advice
 
 
 
7. When was the last time you changed your doctor/ clinic/ hospital? (select one)
 
Never in U.A.E
 
Once in the last 2 years
 
Once in the last 5 years
 
several times
 
 
 
8. Please mark a reason for changing your doctor/ clinic/ hospital? (select one)
 
Clinical expertise
 
Looks/ Grooming of the Doctor
 
International Degree
 
Location
 
Vast Experience
 
Friends/ Family Advice
 
 
 
9. In case of emergency, do you choose a doctor/ clinic/ hospital by? (select one)
 
Clinical expertise
 
Looks/ Grooming of the Doctor
 
International Degree
 
Location
 
Vast Experience
 
Friends/ Family Advice
 
 
 
10. In an elective treatment (where it is not an emergency), do you choose a doctor/ clinic/ hospital by? (select many)
 
Clinical expertise
 
Looks/ Grooming of the Doctor
 
International Degree
 
Location
 
Vast Experience
 
Friends/ Family Advice

 
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