Victoria, BC

Victoria Gynecology & Continence Clinic

Feedback Form

Our goal is to provide you with the best service possible. Please complete this questionnaire after you have visited our office. Your feedback is appreciated.

If you would prefer to print the form and return it to our office in person, you can download it here: Feedback Form

Please click on your response:

My treatment by the reception staff was (1=Poor, 5=Excellent):

 

The office environment was (1=Poor, 5=Excellent):

 

Time for my visit was (1=Poor, 5=Excellent):

 

My problem was satisfactorily understood (1=Poor, 5=Excellent):

 

I feel the quality of the examination was (1=Poor, 5=Excellent):

 

My overall impression of my visit was (1=Poor, 5=Excellent):

 

*Please note that unless encrypted, email messages sent via the internet may not be secure and could be intercepted and read by someone else. Please bear this in mind when deciding whether to include personal or sensitive information in any email messages you intend to send. The office of Dr. David Quinlan accepts no responsibility for any information submitted that fails to reach its intended recipient.