Hugh Wynter Institute for Reproductive Healthcare & Endoscopic Surgery

Customer Service Feedback

Submitted by Anonymous (not verified) on Fri, 02/19/2016 - 15:18

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Date of visit: *

Month

Day

Year

Time of visit: *

Hour

Minute

How would you rate the overall service you received: *

Section visited: *

How would you rate our staff: *

	Excellent	Good	Satisfactory	Poor	Very Poor
Courteous *	Courteous - Excellent	Courteous - Good	Courteous - Satisfactory	Courteous - Poor	Courteous - Very Poor
Sensitive *	Sensitive - Excellent	Sensitive - Good	Sensitive - Satisfactory	Sensitive - Poor	Sensitive - Very Poor
Helpful *	Helpful - Excellent	Helpful - Good	Helpful - Satisfactory	Helpful - Poor	Helpful - Very Poor
Respectful *	Respectful - Excellent	Respectful - Good	Respectful - Satisfactory	Respectful - Poor	Respectful - Very Poor
Professional *	Professional - Excellent	Professional - Good	Professional - Satisfactory	Professional - Poor	Professional - Very Poor
Pleasant *	Pleasant - Excellent	Pleasant - Good	Pleasant - Satisfactory	Pleasant - Poor	Pleasant - Very Poor
Patience *	Patience - Excellent	Patience - Good	Patience - Satisfactory	Patience - Poor	Patience - Very Poor

Additional Comments:

Optional: "Please tell us how we could improve our service to you"