Patient Feedback Form

Canberra Heart Clinic > Patient Feedback Form

    Patient Feedback Form

    The service you received:
    ConsultationElectrocardiogram (ECG)Exercise stress echo24-Hour Ambulatory Blood Pressure MonitorDevice Interrogation and ConsultationEchocardiogramExercise Stress EchocardiogramHolter Monitor

    1) How would you rate clearness of instructions provided before your visit?*
    ExcellentGoodFairPoor

    2) Please rate quality of explanation from the staff regarding what would happen during your service.*
    ExcellentGoodFairPoor

    3) Please rate the overall service received during the visit.*
    ExcellentGoodFairPoor

    4) What most impressed you about the practice?

    5) What least impressed you about the practice?

    6) How can we improve our service?

    General Comments (if any):

    Please list your name and phone number if you would like us to contact you with regards to your feedback.

    Name:

    Contact Number: