Questionnaire for Patients of BCVI

Dear Participants,
We are students of the University of Belize and we are conducting a patient satisfaction survey
for the Belize Council for the Visually Impaired. All your information on this questionnaire will be
kept confidential so we kindly ask that you answer as honestly as possible.
Thank you for your cooperation,
The Think Thank

Answer ALL the questions by placing a tick on the line that most accurately suits you.
1) How old are you?
_18-29
_ 30-49
_ 50-69
_ Other
2) What is your gender?
_ Male
_ Female
3) Is this the first time coming for a service from BCVI?
_ Yes
_ No
If yes, where did you find out about the services offered? __________
If no, how many times have you been getting treatment? __________
4) What service are you receiving?
________________________________________________________
5) Is the service within your price range?
_ Yes
_ No
If no, has the price range been adjusted to suit your expense? _______
6) Have you told anyone in Belize about your BCVI expense?
_ Yes
_ No
7) Has anyone from Belize told you about their expense in BCVI?
_ Yes
_ No

8) Do you think implementing a payment plan in BCVI would be a good idea?

_ Yes
_ No
9) Would you get treatment from BCVI again?
_ Yes
_ No
10) In your opinion, do you think the prices of BCVI are fair?
_ Yes
_ No
If no, why? _________________________________________________
11) Are you satisfied with the services given by the doctor/nurses and other employees?
_ Yes
_ No
If no, why? _________________________________________________
12) Do you have any comment for BCVI?
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________