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Evaluation Form - NewLife Fertility Centre

We at NewLife value our patient opinions and suggestions and we strive for excellence. We use this evaluation form along with other tools to continuously improve our service and help us meet our clients needs. Please take a moment to fill this form. Are you a patient of the Centre? yes no   How did you learn about the Centre? Family Dr. Referral Family/Friend Internet Yellow Pages Advertisement   If you have been to the Centre how would you rate the following:   Poor Fair Satisfactory Good Excellent Reception Nursing Staff Ultrasound Tech Doctors   Did you receive enough information about your treatment? Were you given enough information about options, risks and alternatives? yes no If you answer "no", what would you have liked to see:   Did you find the staff at the center accessible, helpful and supportive? yes no If you answer "no", what would you have liked to see:   How would you rate your overall experience at the center: Poor Fair Satisfactory Good Excellent   Would you recommend this facility to your family or friends? yes no If you answered, "no" please tell us why?   Other Suggestions:   Optional Information: Your Name Telephone Number       ........................................................................................................................

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