Is this your first visit or a return visit to the ABC clinic?
What is the main reason for your visit to the ABC clinic?
Medical staffs shown on TV
Article(s) in newspaper or magazine
Advertisement in newspaper or magazine
Advertisement on TV
Advertisement in the bus or subway
Advertisement on the Internet
Friend or acquaintance recommendation
Review on the Internet
What is the main reason for your revisit to the ABC clinic? (Only applicable for returning customers)
Competence of the medical staff
Friendliness of the medical staff
Friendliness of the employees
What is your biological gender?
What is your age group?
20 ~ 25
26 ~ 30
31 ~ 35
36 ~ 40
41 ~ 45
46 ~ 50
51 ~ 55
56 ~ 60
61 ~ 65
66 ~ 70
Were you satisfied with our hospital to recommend us to your friends or colleagues?
Do you intend to continue using our hospital?
Please select all area where our hospital needs improvement
Less skilled doctors
Lacking or old facilities
Difficult to find
Long wait time
Short counseling and consultation time
Complicated reservation, reception, payment process
No improvement necessary
Please select all area where our hospital is exceptional
Easy to find
Short wait time
Sufficient counseling and consultation time
Convenient reservation, reception, payment process
No exceptional areas
Lastly, please feel free to leave any comments, suggestions, commendations, or complaints you may wish to express to our hospital