Patient Survey

Patient Satisfaction Survey


 

Please download a PDF of the survey and fax, email or drop off the completed document to our office


 

Kitchener-Cambridge Sleep Centres: (fax) 519-579-9371 (email) office@kclsleepcentre.com

London Sleep Centre: (fax) 519-685-7338 (email) london@kclsleepcentre.com


KITCHENER-CAMBRIDGE-LONDON SLEEP CENTRES
Patient Satisfaction Survey

Please indicate facility (ies) being reviewed:____________________________________
In a continuing effort to ensure quality patient care, please answer the following questions:
Did you have difficulty finding our facility? Yes No
Did you have difficulty finding parking? Yes No
Were you given enough information to prepare for the sleep test? Yes No
Were all your questions answered by the technologist? Yes No
Was the wait time for the appointment reasonable? Yes No


Please rate us from a scale of 1 (POOR) to 5 (EXCELLENT) for the following:
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 satisfaction of care at our facility
1            2            3            4             5


Please include any additional comments below:
________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Thank you for participating in this survey.

Adapted from Clinical Practice Parameters and Standards‐Sleep Medicine 3rd Edition