Feasibility Questionnaire Form

A feasibility questionnaire form is a document comprising of a set of questions, to find out the feasibility or potentiality of any institution or organization. It is usually filled in by customers and clients for shops, health centers, malls and other related centers. It is an effective means of testing the feasibility of an organization and find out its strengths and weaknesses.

Sample Feasibility Questionnaire Form:

Health Center Feasibility Questionnaire

Name: __________________

Address: _________________

Patient code: ______________

1. How frequently do you visit this center?

_____________________________________________________________________

2. Why did you choose this particular health center over other?

_____________________________________________________________________

3. What is the name of your physician?

_____________________________________________________________________

4. Are you satisfied with his diagnosis and treatment skill?

_____________________________________________________________________

5. What do you think about his drug selection? How effective is it?

_____________________________________________________________________

6. What kinds of tests are done in the pathological labs? Do you get all your tests done?

_____________________________________________________________________

7. What do you think about the rate of the physician and the cost of treatment?

_____________________________________________________________________

8. What is your opinion about the hygiene of the health centre?

_____________________________________________________________________

9. Is the service hospitable and warm?

_____________________________________________________________________

10. What can we do to serve you better?

____________________________________________________________________

11. How would you rate our overall services out of ten?

____________________________________________________________________

____________________

(Signature of manager)

Download Feasibility Questionnaire Form

Category: Questionnaire Forms