Medicover feedback form

The clinic where you had the appointment *

The physician with whom you had the appointment *

1. Do you have a Medicover subscription? *

2. How do you rate the openness and attitude of the Medicover staff ? *

3. How do you rate the quality and amount of information provided by: *

4. How do you rate the availability of appointments made in our Call Center *

	Very Pleased	Pleased	Satisfied	Unsatisfied	Very unsatisfied	I have not interacted
Telephone waiting time
Schedule for a convenient date

5. How do you evaluate our services?*

	Very Pleased	Pleased	Satisfied	Unsatisfied	Very unsatisfied	I have not interacted
Quality of the medical act
Quality of Medicover general services

6. What do you appreciate most at Medicover?

7. What are your recommendations to improve our services?

8. Do you wish to receive news and medical advices for a better health with the Medicover newsletter?

Contact information

Name

Surname

Telephone

E-mail *

* - Mandatory fields

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