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City of London Health & Social Care Service Feedback
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1.
Question 1.
For which service are you providing feedback? (Please write the name of the service)
Required
- Required.
2.
Question 2.
Summarise your experiene of using the service
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3.
Question 3.
How long ago did you last use the service?
Required
- Required.
Within the last week
Within the last month
Within the last six months
More than six months ago
I have not used the service
*
4.
Question 4.
How likely is it that you would recommend this service to a friend or colleague?
Required
- Required.
0 out of 10
1 out of 10
2 out of 10
3 out of 10
4 out of 10
5 out of 10
6 out of 10
7 out of 10
8 out of 10
9 out of 10
10 out of 10
0=Not at all likely. 10=Extremely likely.
Not at all likely
Extremely likely
5.
Question 5.
How would you rate the service for the following:
Bad
Poor
Okay
Good
Excellent
Cleanliness
Bad
Poor
Okay
Good
Excellent
Staff Attitude
Bad
Poor
Okay
Good
Excellent
Waiting Time
Bad
Poor
Okay
Good
Excellent
Treatment explanation
Bad
Poor
Okay
Good
Excellent
Quality of care (if applicable)
Bad
Poor
Okay
Good
Excellent
Quality of food (if applicable)
Bad
Poor
Okay
Good
Excellent
6.
Question 6.
Is there anything else you would like to say about the service?
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