Patient Satisfaction Survey

Malvern Sleep Clinic

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Patient Information

Last Name *

First Name *

Date of Birth *

Patient Satisfaction Survey

Question Narrative	Response Options
1. Did you have any difficulty with our location or parking?	Yes No
2. When you had your consultation with the physician, did they adequately address your concerns?	Yes No
3. Were you given enough information to prepare for the sleep test?	Yes No
4. Were all your questions answered by the technologist?	Yes No
5. Was your waiting time for the appointment reasonable?	Yes No

6. Rate us on a scale of 1 (POOR) to 5 (EXCELLENT):

Cleanliness of the clinic

1 2 3 4 5

Noise level in the bedroom

1 2 3 4 5

Room temperature

1 2 3 4 5

Professionalism of our staff

1 2 3 4 5

Staff's willingness and Promptness to assist you

1 2 3 4 5

Overall, how satisfied you are with the care at our facility

1 2 3 4 5

Any additional comments:

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After providing an excellent service to our patients for the last 23 years, Malvern Sleep Clinic is pleased to announce that in addition to Dr. Sukarno N Chaudhry who is our medical director, we are adding four more sleep specialists to meet our multi-disciplinary patients comprehensive care needs. Accredited ICHSC Integrated Community Health Services Centres Quality Assurance Program

1371 Neilson Road, Suite 306 Scarborough, Ontario M1B 4Z8

Patient Satisfaction Survey

6. Rate us on a scale of 1 (POOR) to 5 (EXCELLENT):

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