Your name

Your email

Date of visit:

Test performed:

1. Did you have any trouble finding the clinic?
YesNo

2. Were you attended to promptly, and courteously upon your arrival?
YesNo

3. Were you taken to the exam room in a reasonable amount of time?
YesNo

4. Was the test explained to you before it was started?
YesNo

5. Were your questions answered satisfactorily?
YesNo

6. Were you treated with courtesy and respect at all times?
YesNo

7. Was your privacy respected during your visit?
YesNo

8. Did you find the atmosphere of the clinic pleasant?
YesNo

9. Would you return to the clinic again for testing?
YesNo

10. Have you used our website www.GAMDI.ca?
YesNo

11. If yes, was it informative and helpful?
YesNo

GENERAL COMMENTS OR SUGGESTIONS FOR IMPROVEMENT