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Medical Practice Charlestown Diagnostic
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Sleep Laboratory Warners Bay
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Contact
Home
About Us
About Sleep Medicine
Our Team
Appointments
Our Locations/Services
Medical Practice Charlestown Diagnostic
Medical Practice Charlestown Treatment
Sleep Laboratory Warners Bay
Resources
Home Sleep Test Set Up
Referrals
Contact
Charlestown clinic appointment evaluation form
Fill in and submit the form on the below.
Date
(DD/MM/YYYY)
Type of Test
*
First visit with doctor
Follow up visit with doctor
First Visit with technician
Follow up visit with technician
Oximetry collection
Actigraphy watch collection
Equipment Purchase
Portable Home study
Equipment drop in visit
1. How satisfied were you with the ease of booking your appointment?
Unsatisfied
Somewhat satisfied
Satisfied
Very satisfied
Please comment
2. How satisfied were you with the information you received prior to your appointment?
Unsatisfied
Somewhat satisfied
Satisfied
Very satisfied
Please comment
3. How satisfied were you with the facility where your appointment took place?
Unsatisfied
Somewhat satisfied
Satisfied
Very satisfied
Please comment
4. How satisfied were you with the helpfulness and knowledge of the staff?
Unsatisfied
Somewhat satisfied
Satisfied
Very satisfied
Please comment
5. How satisfied were you with the follow up service and help you received after your appointment?
Unsatisfied
Somewhat satisfied
Satisfied
Very satisfied
Please comment
6. Would you recommend Sleep Medicine to others?
Yes
No
Please comment
7. How did you hear about us?
GP/Specialist
Facebook
Internet
Website
Word of mouth
Yellow Pages
Newspaper/Magazine
Other
If other, please specify
We would love to hear any additional comments you have regarding your experience:
If you are happy for a staff member to call, email or write to you, regarding your valued comments please write your fill in your details below
Name
Email
Phone
Address
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Thank you!
