# Clinic feedback access survey

Evaluate nonclinical feedback routes.

If nothing was unclear or difficult, say so. Skip questions about steps you did not experience; use not applicable where appropriate.

## 1. How did you find the feedback route?

Answer: ____________________

## 2. Which submission instruction was unclear?

Answer: ____________________

## 3. What acknowledgment did you expect?

Answer: ____________________

## Author notes / illustrative keys where applicable

1. Read for route discovery. Keep the specific explanation in the respondent’s own words rather than converting it into an unexplained overall satisfaction score.
2. Read for submission clarity. Keep the specific explanation in the respondent’s own words rather than converting it into an unexplained overall satisfaction score.
3. Read for acknowledgment. Keep the specific explanation in the respondent’s own words rather than converting it into an unexplained overall satisfaction score.

Interpretation caution: Do not collect medical concerns in this survey.