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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 Home Sleep Test evaluation form
Fill in and submit the form on the below.
Date
(DD/MM/YYYY)
Portable Home Study Questionnaire
1. Were there any issues when setting up the device?
Yes
No
If so, please comment
2. At any point during the sleep study did any electrodes / equipment become dislodged?
Yes
No
If so, please comment:
3. Did you attempt to reattach dislodged equipment?
Yes
No
Not applicable
Patient Satisfaction Survey
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 information given to set yourself up for your home study?
Unsatisfied
Somewhat satisfied
Satisfied
Very satisfied
Please comment
6. Would you recommend Sleep Medicine to others?
Yes
No
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!
