BASIC HEALTH CHECK-UP FEEDBACK FORM

Thank you for participating ….In our efforts to serve you better, your feedback is very important to us and we welcome your comments about the services you received during the health check-up.  

PARTICIPANT INFORMATION

Date


1. Did you find the basic health check up to be well organized?
PoorFairGoodVery GoodExcellent
2. How was the overall experience in terms of waiting time, logistics, etc
Time taken less than 15 minsTime taken 15 to 30 minsTime taken more than 30 mins
3. Was the staff approachable?
YesNo
4. Were your queries addressed properly?
YesNo
5. How would you rate the following at your campus during your basic health check-up?
Please rate between 1 to 5 with 5 being the highest score.
Arrangement 12345
Hygiene 12345
Overall 12345
6. Please provide your overall feedback towards the program.