Self-verified patient's Story

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    How did you hear about us?:

    About the Doctor

    Was the doctor polite and
    considerate?

    Option A
    Option B
    Option C
    Option D
    Option E

    Did the doctor listen to
    what you had say?

    Option A
    Option B
    Option C
    Option D
    Option E

    Did the doctor give you enough
    opportunity to ask questions?

    Option A
    Option B
    Option C
    Option D
    Option E

    Did the doctor answer
    all your questions?

    Option A
    Option B
    Option C
    Option D
    Option E

    Did the doctor explain
    things in a way you could understand?

    Are you invloved as much as you want to be
    in the decisions about your care and treatment?

    Did you have confidence
    in your doctor?

    Did the doctor respect
    your views?

    If the doctor examined you, did
    he/she: ask your permission and respect you privacy and dignity?

    By the end of the consultaion, did you feel better able to understand and / or
    manage your conditions and your care?

    Overall how satisfied were you
    with the doctor you saw?

    Option A
    Option B
    Option C
    Option D
    Option E

    Gender of Patient

    Is English your first language?

    Who is filling out this form?

    Age of Patient

    Age of Patient

    Comments: Explained Very thoroughly and Very pleased with the consultation