Jewel Support - Customer Service Evaluation Form
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1. Are you filling in this evaluation form for?
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Myself
Spouse or Partner
Child
Relative
Friend
Client
2. Overall, please rate the quality of service you received.
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Very Good
Good
Neutral
Poor
Very Poor
3. At my initial assessment, my views were listened to and my needs were met.
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Strongly Agree
Agree
Unsure
Disagree
4. Was the nurse on time for the assessment?
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Yes
No
5. Did the nurse address your questions or concerns to your satisfaction during or after the assessment?
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Yes
No
6. Did the nurse satisfactorily and adequately explain your condition?
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Yes
No
7. How knowledgeable was the nurse who assisted you?
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Extremely knowledgeable
Very knowledgeable
Somewhat knowledgeable
A little knowledgeable
Not at all knowledgeable
8. How would you rate our concern for your privacy?
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Outstanding
Good
Needs Imporvement
Poor
9. Please rate the speed of our services
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Very Good
Good
Neutral
Poor
Very Poor
10. Would you recommend our services to others?
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Yes
Maybe
No
Submit