Feedback Form - Douglass Hanly Moir Pathology · feedback is important and will assist us to...
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Feedback Form
Transcript of Feedback Form - Douglass Hanly Moir Pathology · feedback is important and will assist us to...
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FeedbackForm
Douglass Hanly Moir Pathology (DHM) and Barratt & Smith Pathology (BSP) aim to provide a high standard of service in a caring and professional manner. Your feedback is important and will assist us to continually improve our services.
Once you have completed thequestionnaire, please press ‘SubmitForm’. Alternatively, you can printthis form and post it to:
Douglass Hanly Moir PathologyPatient ServicesLocked Bag 145,North Ryde NSW 1670
You may also like to email your feedback to [email protected].
We thank you for your feedback.
Please select your responses to the questions below.
Was this your first time in aDHM or BSP collection centre? YES NO
If No: Do you attend this collection centre regularly?
Were the collection staff professional and courteous? YES NO
Upon arrival at the rooms, were you given attention in a timely fashion?
YES NO
Was your wait time acceptable? YES NO N/A
If No: How long were you waiting?
Did the staff identify themselves to you or have a visible name badge?
YES NO
Did the staff ask you to spell your name and state your date of birth?
YES NO N/A
Did staff ask you to check your personal details? YES NO N/A
This questionnaire should only take a minute of your time. Your feedback is valuable to us.
Collection centre:
Date of service: / /
Was the procedure clearly explained to you? YES NO N/A
If instructions were required for your specimen collection, were these clear?
YES NO N/A
Were your specimens labelled in your presence? YES NO
Were you asked to check these details? YES NO
Was the facility clean and tidy? YES NO
Were your questions and concerns addressed to your satisfaction?
YES NO
Were you given clear information regarding your account? YES NO
Were you given clear information regarding ‘post blood collection’ care?
YES NO N/A
Did the staff respond appropriately to your needs? YES NO
Would you recommend our pathology service to others? YES NO
Please rate the overall service you received today
(Unsatisfactory) 1 2 3 4 5 (Excellent)
If you have any compliments, suggestions for improvement, or issues of concern that requires our attention, please provide details below.
Contact details
Name
Address
Phone/Mobile
Doctor’s name
Doctor’s address
Should you wish to provide feedback anonymously, contact details can be excluded, however, please note
that we may not be able to adequately address the matter or provide a response without this information.
DOUGLASS HANLY MOIR PATHOLOGY
14 GIFFNOCK AVENUE • MACQUARIE PARK • NSW 2113 • AUSTRALIAP +61 2 9855 5222 • F +61 2 9878 5077 • E [email protected]
www.dhm.com.au Co
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