Patient Survey

This survey is about all aspects of the service you have received from The Harley Street ENT Clinic. We thank you very much for completing and returning it; these surveys help us ensure that we carefully monitor and improve areas of our care that are important to you.

Please tick the relevant box for each answer. All fields marked * are compulsory.

Who did you see at your last visit? (optional)





About You


MaleFemale


Under 2021-3536-5051-6566 +

Telephone Contact

How would you rate the following?


PoorFairGoodExcellentNot applicable


PoorFairGoodExcellentNot applicable

On Arrival

How would you rate:


PoorFairGoodExcellent


PoorFairGoodExcellent


Quality


YesNo


Under 15 mins16-30 mins31-45 minsOver 46 minsNot applicable

Overall, how would you rate the service you received from:


PoorFairGoodExcellentNot applicable


PoorFairGoodExcellentNot applicable


PoorFairGoodExcellentNot applicable


PoorFairGoodExcellentNot applicable


PoorFairGoodExcellentNot applicable



YesNo


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Type the letters or numbers in the above image.*