Clinic Feedback Survey

 

It has been our pleasure to deliver a Brady and Associates Inc. health promotion initiative, the Corporate Flu Clinic Program, to the employees of your organization. We are committed to providing our clients with the highest level of service possible. To this end, we would greatly appreciate if you could take a few minutes to complete the following questionnaire. Your feedback will help us to continually improve the service we provide.



 

Did you get the Flu shot last year?
Yes
No

If yes, did you notice an improved health status because of the Flu shot?
Yes
No

Did other members of your family get the Flu shot?
Yes
No

Did they have a healthy Flu season?
Yes
No

If your children were vaccinated last year, where did they get the Flu shot?

Public clinic

Doctor's office

School

Other:

If given the option, where would you prefer to take your child to be vaccinated?

Work

School

Doctor's office

Public clinic

Other:

Why do you get the Flu shot?

Convenience

Health security

Concern about lost-time at work

Other:

To your knowledge, did any of your colleagues take time off last year due to Flu-related illness?
Yes
No

To your knowledge, did any of your colleagues that GOT the shot get the Flu?
Yes
No

From your perspective, did you feel more personal health security knowing that your workplace was vaccinated against the Flu?
Yes
No

This Year...

1. How satisfied were you with the service?

Not at All

Indifferent

Satisfied

Very Satisfied

2. How would you rate the information provided to the participating employees prior to receiving the vaccination?

Poor

Fair

Good

Excellent

3. How would you describe the service delivery on clinic day?

Organized

Professional

Equipped to handle an emergency situation

Helpful in answering employee’s questions

4. Please indicate your impression of the benefits of our Corporate Flu Vaccination Program:

Endorses health promotion

Educates employees

Demonstrates commitment to employee health

Next Year...

Would you get a Flu shot next year if it were offered at your workplace?
Yes
No

Would you get a Flu shot elsewhere if it were NOT offered at your workplace next year?
Yes
No

If given the option to bring your family members to your workplace clinic would you accept?
Yes
No

If yes, what is your strongest reason?

Convenience

Less exposure to public illness

Less wait time

Other:

How would you suggest that we improve our service during next year’s Flu season?

Thank you for your time.

Name:

Organization:



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