1. Gender
Female Male
2. Age
18-30 31-45 46-60 more than 61
3. Place of residence
4. How was your appointment arranged?
By telephone In person Online registration Patient Portal
5. How would you rate the registration system at SPEKTRUM:
• Possibility of contacting the Centre by phone?
Very good Good Bad Rather bad Notes:
• Courtesy and helpfulness of the registration staff?
Very good Good Bad Rather bad
• Efficiency of patient service?
Very good Good Bad Rather bad
• Is the information provided by the registration staff:
Clear Comprehensive Unclear
6. How would you rate your medical visit at SPEKTRUM?
• The doctor's attitude towards the patient (commitment, kindness, interest)
Very good Good Bad Rather bad Notes:
• Level of communication (clarity of diagnosis, medical recommendations)
Very good Good Bad Rather bad
7. How would you rate the services provided by optometrists?
• Optometrist's attitude towards the patient (commitment, kindness, interest)
Very good Good Bad Rather bad Notes:
8. How would you rate the nursing services?
• Nurse's attitude towards the patient:
Very good Good Bad Rather bad Notes:
9. How did you hear about SPEKTRUM?
Internet From a doctor/ophthalmologist Recommendation from family/friends Other
If other, please specify:
10. How likely is it that you would recommend SPEKTRUM medical services to your family or friends?
(0 = definitely would not recommend, 10 = definitely would recommend)
11. Is there anything you think we could improve/enhance in our Clinic?
No I have no opinion Yes Notes:
12. Have you seen our advertising campaign on social media?
No Yes
Which social media?
13. Do you use the Patient Portal?
Yes, regularly Yes, occasionally No, but I know about it No, I didn't know it existed
I have read the privacy policy, and I consent to the processing of my personal data for statistical purposes. (Full content of the information clause ).
The Personal Data Controller (PDC) is SPEKTRUM Sp. z o.o. with its registered office in Wrocław (53-334), ul. Zaolziańska 4, entered in the National Court Register managed by the District Court for Wrocław Fabryczna in Wrocław 6th Commercial Division of the National Court Register under No. 0000 016 751, REGON (National Business Registry No.) 932 632 951, NIP (taxpayer ID No.): 897 16 58 338. Privacy policy | GDPR information clause Privacy policy | GDPR information clause