Information for patients Outpatient Clinic visited* Date of visit* DD dash MM dash YYYY Doctor Showed real interest*TOTALLY DISAGREERATHER DISAGREENEITHER AGREE OR DISAGREERATHER AGREETOTALLY AGREEInspired confidence*TOTALLY DISAGREERATHER DISAGREENEITHER AGREE OR DISAGREERATHER AGREETOTALLY AGREEGave adequate instructions*TOTALLY DISAGREERATHER DISAGREENEITHER AGREE OR DISAGREERATHER AGREETOTALLY AGREESpend adequate time on my health problem*TOTALLY DISAGREERATHER DISAGREENEITHER AGREE OR DISAGREERATHER AGREETOTALLY AGREEWas polite*TOTALLY DISAGREERATHER DISAGREENEITHER AGREE OR DISAGREERATHER AGREETOTALLY AGREE Nurse Showed real interest*TOTALLY DISAGREERATHER DISAGREENEITHER AGREE OR DISAGREERATHER AGREETOTALLY AGREEGave adequate instructions*TOTALLY DISAGREERATHER DISAGREENEITHER AGREE OR DISAGREERATHER AGREETOTALLY AGREEWas polite*TOTALLY DISAGREERATHER DISAGREENEITHER AGREE OR DISAGREERATHER AGREETOTALLY AGREE Secretary Complete the procedures without delays*TOTALLY DISAGREERATHER DISAGREENEITHER AGREE OR DISAGREERATHER AGREETOTALLY AGREEGave clear answers to my questions*TOTALLY DISAGREERATHER DISAGREENEITHER AGREE OR DISAGREERATHER AGREETOTALLY AGREEWas polite*TOTALLY DISAGREERATHER DISAGREENEITHER AGREE OR DISAGREERATHER AGREETOTALLY AGREE General Ο χρόνος στην αίθουσα αναμονής ήταν ελάχιστος*TOTALLY DISAGREERATHER DISAGREENEITHER AGREE OR DISAGREERATHER AGREETOTALLY AGREEThe premises were clean*TOTALLY DISAGREERATHER DISAGREENEITHER AGREE OR DISAGREERATHER AGREETOTALLY AGREEI would recommend the Outpatient Clinics to third parties*TOTALLY DISAGREERATHER DISAGREENEITHER AGREE OR DISAGREERATHER AGREETOTALLY AGREE Required Optional Gender* Man Woman Name Age* 18-30 31-50 51-70 70+ Last name Education level* Primary education Secondary Education Higher education PhoneEmailThis field is for validation purposes and should be left unchanged.
