Patient-Doctor Relationship Survey Template

Welcome to this survey on patient-doctor relationship. Please answer all questions based on your actual experience, all responses will be kept strictly confidential. There are no right or wrong answers.
*

Your gender

Male
Female
Prefer not to disclose
*

Your age group

Under 18 years old
18-25 years old
26-30 years old
31-40 years old
41-50 years old
51-60 years old
Over 60 years old
Prefer not to disclose
*

Have you received outpatient or inpatient medical services at a formal medical institution in the past 2 years?

Yes
No
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