Mystery shopper feedback form

After you have had contact with a healthcare service, which might be through an appointment, a letter or phone call, please give feedback on your experience, good or bad, by completing the short questionnaire below. All feedback will be completely confidential. Your identity will remain anonymous.

1.  Name of organisation feedback relates to:

2.  Name of site and department feedback relates to

3.  Date of visit

4.  Tell us more about your experience

Include details about staff attitude, waiting time, quality of care, and whether treatment was explained to you.

5.  Is there a member of staff or team that you would like to mention who were particularly helpful?

Please answer the following question

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