Well being 問卷(普通客戶) – CWB

能為閣下服務是我們的榮幸。我們一向以客人的意見為基礎,從而不斷提升服務水平。您可以給我們寶貴的意見嗎?
It is our honor to serve you. We value customers' opinions and count on them to enhance the service standard. Would you give us your valuable comments?

(請選出您的意見 Please choose your choices)

診所 Clinic *

	非常滿意 Excellent	滿意 Good	一般 Fair	不滿意 Poor
診所地點 Location of Clinic	診所地點 Location of Clinic 非常滿意 Excellent	診所地點 Location of Clinic 滿意 Good	診所地點 Location of Clinic 一般 Fair	診所地點 Location of Clinic 不滿意 Poor
整潔 Tidiness	整潔 Tidiness 非常滿意 Excellent	整潔 Tidiness 滿意 Good	整潔 Tidiness 一般 Fair	整潔 Tidiness 不滿意 Poor
環境及設施 Environment & Facilities	環境及設施 Environment & Facilities 非常滿意 Excellent	環境及設施 Environment & Facilities 滿意 Good	環境及設施 Environment & Facilities 一般 Fair	環境及設施 Environment & Facilities 不滿意 Poor

牙醫 Dental Surgeon / 高級洗牙師 Hygienist *

	非常滿意 Excellent	滿意 Good	一般 Fair	不滿意 Poor
專業意見 Professional Comments	專業意見 Professional Comments 非常滿意 Excellent	專業意見 Professional Comments 滿意 Good	專業意見 Professional Comments 一般 Fair	專業意見 Professional Comments 不滿意 Poor
服務態度 Service Attitude	服務態度 Service Attitude 非常滿意 Excellent	服務態度 Service Attitude 滿意 Good	服務態度 Service Attitude 一般 Fair	服務態度 Service Attitude 不滿意 Poor
洗牙 scaling & polishing	洗牙 scaling & polishing 非常滿意 Excellent	洗牙 scaling & polishing 滿意 Good	洗牙 scaling & polishing 一般 Fair	洗牙 scaling & polishing 不滿意 Poor
其他治療 Other Treatments	其他治療 Other Treatments 非常滿意 Excellent	其他治療 Other Treatments 滿意 Good	其他治療 Other Treatments 一般 Fair	其他治療 Other Treatments 不滿意 Poor

客戶服務 Customer Service *

	非常滿意 Excellent	滿意 Good	一般 Fair	不滿意 Poor
接待員的態度 Attitude of Receptionist	接待員的態度 Attitude of Receptionist 非常滿意 Excellent	接待員的態度 Attitude of Receptionist 滿意 Good	接待員的態度 Attitude of Receptionist 一般 Fair	接待員的態度 Attitude of Receptionist 不滿意 Poor
牙醫助護的態度 Attitude of Dental Assistant	牙醫助護的態度 Attitude of Dental Assistant 非常滿意 Excellent	牙醫助護的態度 Attitude of Dental Assistant 滿意 Good	牙醫助護的態度 Attitude of Dental Assistant 一般 Fair	牙醫助護的態度 Attitude of Dental Assistant 不滿意 Poor

其他意見

姓名 Name: *

公司名稱 Company Name: *

聯絡電話 Contact No.: *

診症醫生姓名 Name of Dental Surgeon: *

診症日期 Date of Consultation: *

您的個人資料只用作統計分析用途。資料絕對保密。

To ensure strict confidentiality, your personal details will be solely used for this survey analysis.