HealthNex — Client Feedback Form
Name (optional)
Date of Visit
Service Used
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Basic Health MOT
Advanced Health MOT
Full Screening
Other
Overall Experience
Excellent
Good
Average
Poor
Booking Process
Excellent
Good
Average
Poor
Staff Professionalism
Excellent
Good
Average
Poor
Quality of Screening Service
Excellent
Good
Average
Poor
Clarity of Results Explained
Excellent
Good
Average
Poor
Were your concerns addressed?
Yes
Partially
No
What did you like most about our service?
What could we improve?
Any other comments or suggestions?
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