Vaccination Clinic Feedback
Flow, wait, information, and aftercare clarity for vaccination drives.
4 questions · 1 page · about 2 minutes to answer · fully editable after you start
High-volume vaccination clinics live on throughput, but the patient memory is made of small things: how the queue moved, whether questions were welcome, and whether aftercare guidance was clear. This survey checks each stage of the flow in under two minutes.
Use it during multi-day drives and review nightly – queue and signage fixes applied between days show up in the next day's scores, and the aftercare-clarity number tells you if your leaflet is working.
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Page 1
Your vaccination visit
This survey is about your visit to the vaccination clinic. Tell us how each stage went, so we can make the next visit easier for everyone. It takes about 2 minutes. This form is not an emergency service. If you need urgent medical help, call your local emergency number.
Q1.How would you rate each stage?*
| Poor | OK | Great | Not applicable | |
|---|---|---|---|---|
| Check-in | ||||
| Queue and waiting | ||||
| The vaccination itself | ||||
| Aftercare instructions |
Q2.Were your questions answered before the jab?
- Yes fully
- Partly
- I had no questions
- No
Q3.Do you know what side effects to expect and when to seek help?*
- Yes, clearly
- Roughly
- No
Q4.Any suggestions for making the clinic run better?
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