Barix Clinics Consultation Feedback Form

Customer Feedback: Bariatric Consultation

Please tell us how we are doing. Choose the appropriate response to each statement below, add comments if desired, and submit. Thank you for taking the time to provide feedback on your experience.

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Surgeon's Name:

Consult Date:

Consult Time:

The appointment today helped me understand how bariatric surgery will help me lose weight.

The appointment today helped me understand the possible risks and complications associated with bariatric surgery.

All of the questions I had about bariatric surgery were answered today.

I am convinced that Barix Clinics is the safest place for me to have bariatric surgery.

I understand how Barix Clinics' approach to weight loss is different from other programs.

If I proceed with surgery, I would like the bariatric surgeon I met today to be my surgeon.

The bariatric surgeon clearly explained the surgical procedure(s).

The bariatric surgeon spent an appropriate amount of time with me.

The appointment today positively influenced my plans to have bariatric surgery.

My appointment was scheduled at a convenient time.

My appointment started promptly at the scheduled time.

Comments:

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