Medical Tourism Experience Survey
Full Name
Email Address
Country of Residence
Destination Country for Treatment
Purpose of Medical Travel
Surgery
Dental Care
Cosmetic Treatment
Fertility Treatment
Wellness/Checkup
Other
Date of Visit
Facility Visited
Overall Satisfaction
1
2
3
4
5
Please rate the following aspects:
Medical Staff
1
2
3
4
5
Facility Cleanliness
1
2
3
4
5
Communication
1
2
3
4
5
Value for Money
1
2
3
4
5
Additional Comments / Suggestions