Trang 1 của 2
It only takes 3-5 minutes to complete Upon completion, you’ll receive a special gift/voucher from DIAG 🎁
PART 1: PERSONAL INFORMATION
Full Name:
*
Phone Number:
*
Email (optional):
Branch:
*
How many times have you visited DIAG Medical Center?
*
PART 2: GENERAL SURVEY
How did you hear about DIAG Medical Center?
*
How did you hear about DIAG Medical Center?
Referred by friends or family
Online ads (Facebook, TikTok, Instagram, etc.)
Outdoor advertising (billboards, flyers, etc.)
Recommended by a doctor/healthcare facility
DIAG branch near my home
Google search
Other
How often do you visit DIAG Medical Center?
*
How often do you visit DIAG Medical Center?
Monthly
Every 2-3 months
Every 4-6 months
Every 6 months
Once a year
Every 1-2 years
What are the main reasons you chose DIAG Medical Center? (Select up to 3)
*
What are the main reasons you chose DIAG Medical Center? (Select up to 3)
Professional, friendly staff
Doctor consultations available
Clean environment
Reasonable pricing
Convenient location
Promotions and discounts
Home sample collection service
Modern equipment and technology
Fast and accurate results
Other
List three things you are satisfied with at DIAG Medical Center:
*
List three things that didn’t meet your expectations
at DIAG Medical Center
?
*
If you could change three things, what would you suggest DIAG Medical Center improve:
*
PART 3: EXPERIENCE & FEEDBACK
Please rate your satisfaction with the following services at DIAG Medical Center:
1. Overall satisfaction with DIAG
*
1. Overall satisfaction with DIAG
Very Dissatisfied
Dissatisfied
Neutral
Satisfied
Very Satisfied
2. Security staff’s attitude
*
2. Security staff’s attitude
Very Dissatisfied
Dissatisfied
Neutral
Satisfied
Very Satisfied
3. Reception staff’s attitude
*
3. Reception staff’s attitude
Very Dissatisfied
Dissatisfied
Neutral
Satisfied
Very Satisfied
4. Nursing staff’s attitude
*
4. Nursing staff’s attitude
Very Dissatisfied
Dissatisfied
Neutral
Satisfied
Very Satisfied
5. Nursing staff’s technical skills
*
5. Nursing staff’s technical skills
Very Dissatisfied
Dissatisfied
Neutral
Satisfied
Very Satisfied
6. Doctor’s attitude
*
6. Doctor’s attitude
Very Dissatisfied
Dissatisfied
Neutral
Satisfied
Very Satisfied
7. Doctor’s expertise
*
7. Doctor’s expertise
Very Dissatisfied
Dissatisfied
Neutral
Satisfied
Very Satisfied
8. Waiting time for consultation/tests
*
8. Waiting time for consultation/tests
Very Dissatisfied
Dissatisfied
Neutral
Satisfied
Very Satisfied
9. Clinic environment
*
9. Clinic environment
Very Dissatisfied
Dissatisfied
Neutral
Satisfied
Very Satisfied
10. Services offered
*
10. Services offered
Very Dissatisfied
Dissatisfied
Neutral
Satisfied
Very Satisfied
11. Pricing
*
11. Pricing
Very Dissatisfied
Dissatisfied
Neutral
Satisfied
Very Satisfied
12. Test result delivery process
*
12. Test result delivery process
Very Dissatisfied
Dissatisfied
Neutral
Satisfied
Very Satisfied
How likely are you to recommend DIAG Medical Center to your friends and family?
*
How likely are you to recommend DIAG Medical Center to your friends and family?
Never recommend
Unlikely
Might recommend
Likely
Definitely recommend
Are there any services/packages/tests you would like DIAG Medical Center to offer?
*
What encourages you to return to DIAG Medical Center? (Select up to 3)
*
What encourages you to return to DIAG Medical Center? (Select up to 3)
Fast and accurate results
Professional, friendly staff
Doctor consultations available
Clean environment
Reasonable pricing
Convenient location
Promotions and discounts
Home sample collection service
Modern equipment and technology
Other
Submit