Questionnaire on Service You Have Got From Aesthetic Clinic in UAE - Paper Example

We would like to know about the quality of service you have got from Aesthetic Clinic in UAE. Please only fill in the questionnaire if you have ever visited an Aesthetic Clinic in UAE. The answers should be in relation to the aesthetic clinic you have visited, or one you visited last (if you have visited a number).

Background

What do you consider as your ethnic group?: (circle one)

White

African-American

Hispanic

Asian

African

Middle Eastern

Other __________________

What is your Gender: (circle one)

Male

Female

What is your Age: (circle one):18-3031-40 41-50Over 50

Service Quality

Please indicate your level of satisfaction with the following items related to your office appointment. Use a scale of 1 to 5, with 5 being Very Satisfied and 1 being Not at all Satisfied. If an item is not related to your care, choose N/A.

1 Not at all Satisfied Neutral Very Satisfied N/A

(1) (2) (3) (4) (5)

Getting through to the office by phone. O O O O O O

The time between your call to schedule an appointment and your appointment date. O O O O O O

The manners of the person(s) who scheduled your appointment. O O O O O O

Clarity of directions to the office and the time of your appointment. O O O O O O

The professionalism and helpfulness of your reception. O O O O O O

Your wait time in the office. O O O O O O

The comfort, cleanliness and amenities of the reception area. O O O O O O

The extent to which staff respected your privacy. O O O O O O

Please rate the following items related to the delivery of your care. Use a scale of 1 to 5, with 5 being Excellent and 1 being Poor. If an item is not related to your care, choose N/A.

2. Poor Excellent N/A

(1) (2) (3) (4) (5)

You physician/providers listening skills. O O O O O O

His or her explanation of procedures, diagnoses or treatment regimen. O O O O O O

His/her personal manner (courtesy, respect, sensitivity, friendliness). O O O O O O

Other staffs personal manner (courtesy, respect, sensitivity, friendliness). O O O O O O

Technical skills (thoroughness, carefulness, competence) of the physician/practitioner. O O O O O O

How prepared (records and educational materials readily available) the staff and physician/provider were for your visit. O O O O O O

Please indicate the extent to which you agree or disagree with each of the following statements. Use a scale of 1 to 5, with 5 being Strongly Agree and 1 being Strongly Disagree. If an item is not related to your care, choose N/A.

3. Strongly Disagree Somewhat Disagree Neutral Somewhat Agree Strongly Agree N/A

(1) (2) (3) (4) (5)

My physician/provider spent adequate time with me. O O O O O O

The service/care provided was valuable to improving my health. O O O O O O

The educational information I received was helpful. O O O O O O

I clearly understand the next steps in my plan of care. O O O O O O

I will continue going to this place in the future. I will recommend this place to my friends O O O O O O

Thank you for your participation