To assist us to continue to provide and improve our services to you the clients, it would be helpful if you could complete this the feedback form below.
Please could you take a few mintues to let us know about our HCA/Nurses' performance to help us improve our services to you.

Please complete the form below, your feedback is important to us.

 You can download this form if you wish. 

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1. Names of the HCA/Nurse:*

MrsMrMsProfDr    

2. How did I perform?*

a) Poor

b) Satisfactory

c) Good

d) Excellent

3. Did our service meet your expectations? Using the scale below*

5 (Excellent)

4 (Good)

3 (Fair)

2 (Poor)

1 (Awful)

4. Would you use Extra Mile HCA/Nurses’ again?*

a) Never

b) Maybe

c) Always

5. What would you want us to improve on? *

Reviewer's Name*

MrsMrMs    

Position Held:*

Email*

Company Name*

Company Telephone*

Company Address*

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