{"id":8716,"date":"2014-07-11T07:14:35","date_gmt":"2014-07-11T05:14:35","guid":{"rendered":"https:\/\/www.laurusmedical.ro\/?page_id=8716"},"modified":"2018-11-07T00:17:15","modified_gmt":"2018-11-06T22:17:15","slug":"formular-de-evaluare","status":"publish","type":"page","link":"https:\/\/www.laurusmedical.ro\/en\/formular-de-evaluare\/","title":{"rendered":"Assessment Form"},"content":{"rendered":"<p><\/p>\n<p style=\"text-align: justify;\">Thank you for trusting our services and we hereby invite you to fill out the form below meant to assess our activity and submit improvement suggestions.<\/p>\n<p style=\"text-align: justify;\">We hereby ensure you on the confidentiality of all collected data, as well as on the fact that it shall only be viewed by the management of Laurus Medical clinics.<\/p>\n<p>\n<div class=\"wpcf7 no-js\" id=\"wpcf7-f13761-o2\" lang=\"en-US\" dir=\"ltr\" data-wpcf7-id=\"13761\">\n<div class=\"screen-reader-response\"><p role=\"status\" aria-live=\"polite\" aria-atomic=\"true\"><\/p> <ul><\/ul><\/div>\n<form action=\"\/en\/wp-json\/wp\/v2\/pages\/8716#wpcf7-f13761-o2\" method=\"post\" class=\"wpcf7-form init\" aria-label=\"Contact form\" novalidate=\"novalidate\" data-status=\"init\">\n<fieldset class=\"hidden-fields-container\"><input type=\"hidden\" name=\"_wpcf7\" value=\"13761\" \/><input type=\"hidden\" name=\"_wpcf7_version\" value=\"6.1.5\" \/><input type=\"hidden\" name=\"_wpcf7_locale\" value=\"en_US\" \/><input type=\"hidden\" name=\"_wpcf7_unit_tag\" value=\"wpcf7-f13761-o2\" \/><input type=\"hidden\" name=\"_wpcf7_container_post\" value=\"0\" \/><input type=\"hidden\" name=\"_wpcf7_posted_data_hash\" value=\"\" \/><input type=\"hidden\" name=\"_wpcf7cf_hidden_group_fields\" value=\"[]\" \/><input type=\"hidden\" name=\"_wpcf7cf_hidden_groups\" value=\"[]\" \/><input type=\"hidden\" name=\"_wpcf7cf_visible_groups\" value=\"[]\" \/><input type=\"hidden\" name=\"_wpcf7cf_repeaters\" value=\"[]\" \/><input type=\"hidden\" name=\"_wpcf7cf_steps\" value=\"{}\" \/><input type=\"hidden\" name=\"_wpcf7cf_options\" value=\"{&quot;form_id&quot;:13761,&quot;conditions&quot;:[],&quot;settings&quot;:{&quot;animation&quot;:&quot;yes&quot;,&quot;animation_intime&quot;:200,&quot;animation_outtime&quot;:200,&quot;conditions_ui&quot;:&quot;normal&quot;,&quot;notice_dismissed&quot;:false,&quot;notice_dismissed_rollback-cf7-5.3.2&quot;:true,&quot;notice_dismissed_rollback-cf7-5.8.3&quot;:true,&quot;notice_dismissed_rollback-cf7-5.8.6&quot;:true}}\" \/><input type=\"hidden\" name=\"_wpcf7dtx_version\" value=\"5.0.5\" \/><input type=\"hidden\" name=\"_wpcf7_recaptcha_response\" value=\"\" \/>\n<\/fieldset>\n<h3>Select the <span style=\"color: #f60\">LaurusMedical<\/span> Branch you are assessing\n<\/h3>\n<p><span class=\"wpcf7-form-control-wrap\" data-name=\"filiala\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"filiala\"><option value=\"\">&#8212;Please choose an option&#8212;<\/option><option value=\"Bucharest\">Bucharest<\/option><option value=\"Bacau\">Bacau<\/option><option value=\"Buzau\">Buzau<\/option><option value=\"Braila\">Braila<\/option><option value=\"Craiova\">Craiova<\/option><option value=\"Deva\">Deva<\/option><option value=\"Focsani\">Focsani<\/option><option value=\"Galati\">Galati<\/option><option value=\"Pitesti\">Pitesti<\/option><option value=\"Ploiesti\">Ploiesti<\/option><option value=\"Suceava\">Suceava<\/option><\/select><\/span>\n<\/p>\n<h5>Select the specialty\n<\/h5>\n<p><span class=\"wpcf7-form-control-wrap\" data-name=\"specialitatea\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"specialitatea\"><option value=\"\">&#8212;Please choose an option&#8212;<\/option><option value=\"proctology\">proctology<\/option><option value=\"flebology\">flebology<\/option><option value=\"dermatology\">dermatology<\/option><option value=\"rheumatology\">rheumatology<\/option><option value=\"cardiology\">cardiology<\/option><option value=\"urology\">urology<\/option><option value=\"gastroenterology\">gastroenterology<\/option><option value=\"internal medicine\">internal medicine<\/option><option value=\"general surgery\">general surgery<\/option><option value=\"dermato-cosmetics\">dermato-cosmetics<\/option><option value=\"obstetrics &amp; gynecology\">obstetrics &amp; gynecology<\/option><option value=\"MBST\">MBST<\/option><option value=\"medical massage\">medical massage<\/option><option value=\"endocrinology\">endocrinology<\/option><option value=\"allergology\">allergology<\/option><option value=\"neurology\">neurology<\/option><option value=\"paediatrics\">paediatrics<\/option><option value=\"nutrition disorders\">nutrition disorders<\/option><\/select><\/span>\n<\/p>\n<h5>How did you find out about <span style=\"color: #f60;\">LaurusMedical<\/span> Network?\n<\/h5>\n<p><span class=\"wpcf7-form-control-wrap\" data-name=\"media\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"media\"><option value=\"\">&#8212;Please choose an option&#8212;<\/option><option value=\"Google\">Google<\/option><option value=\"Youtube\">Youtube<\/option><option value=\"Facebook\">Facebook<\/option><option value=\"sfatulmedicului.ro\">sfatulmedicului.ro<\/option><option value=\"a friend recommended it\">a friend recommended it<\/option><option value=\"physician\u2019s referral\">physician\u2019s referral<\/option><\/select><\/span>\n<\/p>\n<h5>Was the appointment hour observed?\n<\/h5>\n<p><span class=\"wpcf7-form-control-wrap\" data-name=\"intarziere\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><input type=\"radio\" name=\"intarziere\" value=\"No\" \/><span class=\"wpcf7-list-item-label\">No<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"radio\" name=\"intarziere\" value=\"Yes\" \/><span class=\"wpcf7-list-item-label\">Yes<\/span><\/span><\/span><\/span>\n<\/p>\n<h5>If not, for how long did you have to wait?\n<\/h5>\n<p><span class=\"wpcf7-form-control-wrap\" data-name=\"timp\"><select class=\"wpcf7-form-control wpcf7-select\" aria-invalid=\"false\" name=\"timp\"><option value=\"\">&#8212;Please choose an option&#8212;<\/option><option value=\"5 minutes\">5 minutes<\/option><option value=\"10 minutes\">10 minutes<\/option><option value=\"15 minutes\">15 minutes<\/option><option value=\"20 minutes\">20 minutes<\/option><option value=\"30 minutes\">30 minutes<\/option><option value=\"1 hour\">1 hour<\/option><\/select><\/span>\n<\/p>\n<h4>Personnel Assessment\n<\/h4>\n<p>Are you satisfied with the appointment telephone conversation?\n<\/p>\n<p><span class=\"wpcf7-form-control-wrap\" data-name=\"ev-operator\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><input type=\"radio\" name=\"ev-operator\" value=\"Yes\" \/><span class=\"wpcf7-list-item-label\">Yes<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"radio\" name=\"ev-operator\" value=\"No\" \/><span class=\"wpcf7-list-item-label\">No<\/span><\/span><\/span><\/span>\n<\/p>\n<p>Are you satisfied with the reception desk\u2019s personnel behavior?\n<\/p>\n<p><span class=\"wpcf7-form-control-wrap\" data-name=\"ev-receptie\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><input type=\"radio\" name=\"ev-receptie\" value=\"Yes\" \/><span class=\"wpcf7-list-item-label\">Yes<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"radio\" name=\"ev-receptie\" value=\"No\" \/><span class=\"wpcf7-list-item-label\">No<\/span><\/span><\/span><\/span>\n<\/p>\n<p>How would you appreciate the behavior of the medical nurses?\n<\/p>\n<p><span class=\"wpcf7-form-control-wrap\" data-name=\"ev-asistente\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><input type=\"radio\" name=\"ev-asistente\" value=\"Good\" \/><span class=\"wpcf7-list-item-label\">Good<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"radio\" name=\"ev-asistente\" value=\"Mediocre\" \/><span class=\"wpcf7-list-item-label\">Mediocre<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"radio\" name=\"ev-asistente\" value=\"Unsatisfactory\" \/><span class=\"wpcf7-list-item-label\">Unsatisfactory<\/span><\/span><\/span><\/span>\n<\/p>\n<p>How would you appreciate the behavior of the attending physician?\n<\/p>\n<p><span class=\"wpcf7-form-control-wrap\" data-name=\"ev-medic\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><input type=\"radio\" name=\"ev-medic\" value=\"Good\" \/><span class=\"wpcf7-list-item-label\">Good<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"radio\" name=\"ev-medic\" value=\"Mediocre\" \/><span class=\"wpcf7-list-item-label\">Mediocre<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"radio\" name=\"ev-medic\" value=\"Unsatisfactory\" \/><span class=\"wpcf7-list-item-label\">Unsatisfactory<\/span><\/span><\/span><\/span>\n<\/p>\n<p>How satisfied would you say you are with the explanations received during the visit?\n<\/p>\n<p><span class=\"wpcf7-form-control-wrap\" data-name=\"ev-consult\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><input type=\"radio\" name=\"ev-consult\" value=\"Completely satisfied\" \/><span class=\"wpcf7-list-item-label\">Completely satisfied<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"radio\" name=\"ev-consult\" value=\"Partially satisfied\" \/><span class=\"wpcf7-list-item-label\">Partially satisfied<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"radio\" name=\"ev-consult\" value=\"Not at all satisfied\" \/><span class=\"wpcf7-list-item-label\">Not at all satisfied<\/span><\/span><\/span><\/span>\n<\/p>\n<p>How satisfied would you say you are with the treatment received within the clinic?\n<\/p>\n<p><span class=\"wpcf7-form-control-wrap\" data-name=\"ev-tratament\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><input type=\"radio\" name=\"ev-tratament\" value=\"Completely satisfied\" \/><span class=\"wpcf7-list-item-label\">Completely satisfied<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"radio\" name=\"ev-tratament\" value=\"Partially satisfied\" \/><span class=\"wpcf7-list-item-label\">Partially satisfied<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"radio\" name=\"ev-tratament\" value=\"Not at all satisfied\" \/><span class=\"wpcf7-list-item-label\">Not at all satisfied<\/span><\/span><\/span><\/span>\n<\/p>\n<h4>Assessment <span style=\"color: #f60;\">LaurusMedical<\/span> experience\n<\/h4>\n<p>What is your opinion about <span style=\"color: #f60;\">LaurusMedical<\/span> in comparatie cu alte clinici medicale private?\n<\/p>\n<p><span class=\"wpcf7-form-control-wrap\" data-name=\"comparatie\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><input type=\"radio\" name=\"comparatie\" value=\"Laurus Medical supersedes other private medical clinics\" \/><span class=\"wpcf7-list-item-label\">Laurus Medical supersedes other private medical clinics<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"radio\" name=\"comparatie\" value=\"Laurus Medical is similar to other private medical clinics\" \/><span class=\"wpcf7-list-item-label\">Laurus Medical is similar to other private medical clinics<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"radio\" name=\"comparatie\" value=\"Laurus Medical is exceeded by other medical clinics\" \/><span class=\"wpcf7-list-item-label\">Laurus Medical is exceeded by other medical clinics<\/span><\/span><\/span><\/span>\n<\/p>\n<p>In general, how do you feel after your visit at <span style=\"color: #f60;\">LaurusMedical<\/span> Clinic?\n<\/p>\n<p><span class=\"wpcf7-form-control-wrap\" data-name=\"ev-generala\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><input type=\"radio\" name=\"ev-generala\" value=\"satisfied\" \/><span class=\"wpcf7-list-item-label\">satisfied<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"radio\" name=\"ev-generala\" value=\"indifferent\" \/><span class=\"wpcf7-list-item-label\">indifferent<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"radio\" name=\"ev-generala\" value=\"dissatisfied\" \/><span class=\"wpcf7-list-item-label\">dissatisfied<\/span><\/span><\/span><\/span>\n<\/p>\n<p>Would you recommend <span style=\"color: #f60;\">LaurusMedical<\/span> services to your friends?\n<\/p>\n<p><span class=\"wpcf7-form-control-wrap\" data-name=\"recomandare\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><input type=\"radio\" name=\"recomandare\" value=\"Yes\" \/><span class=\"wpcf7-list-item-label\">Yes<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"radio\" name=\"recomandare\" value=\"Maybe\" \/><span class=\"wpcf7-list-item-label\">Maybe<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"radio\" name=\"recomandare\" value=\"No\" \/><span class=\"wpcf7-list-item-label\">No<\/span><\/span><\/span><\/span>\n<\/p>\n<p>What would you say our strengths are and where, in your opinion, there\u2019s room for improvement?\n<\/p>\n<p><span class=\"wpcf7-form-control-wrap\" data-name=\"opinie\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea\" aria-invalid=\"false\" name=\"opinie\"><\/textarea><\/span>\n<\/p>\n<h4>About you (optional)\n<\/h4>\n<p>Your name &nbsp;&nbsp; <span class=\"wpcf7-form-control-wrap\" data-name=\"numele\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"numele\" \/><\/span>\n<\/p>\n<p>Your email address <span class=\"wpcf7-form-control-wrap\" data-name=\"emailul\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-email wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-email\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"email\" name=\"emailul\" \/><\/span>\n<\/p>\n<p>Do you want to subscribe to our newsletter? <span class=\"wpcf7-form-control-wrap\" data-name=\"abonare-news\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><input type=\"radio\" name=\"abonare-news\" value=\"yes\" \/><span class=\"wpcf7-list-item-label\">yes<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"radio\" name=\"abonare-news\" value=\"no\" \/><span class=\"wpcf7-list-item-label\">no<\/span><\/span><\/span><\/span>\n<\/p>\n<p>Your personal data (surname, name, e-mail) is optional and shall only be used if you request an answer to your comment. The personal data shall be processed for our legitimate interests only.\n<\/p>\n<p><input class=\"wpcf7-form-control wpcf7-submit has-spinner\" type=\"submit\" value=\"Submit\" \/>\n<\/p><div class=\"wpcf7-response-output\" aria-hidden=\"true\"><\/div>\n<\/form>\n<\/div>\n<br \/>\n<\/p>","protected":false},"excerpt":{"rendered":"<p>Thank you for trusting our services and we hereby invite you to fill out the [&hellip;]<\/p>\n","protected":false},"author":2,"featured_media":11317,"parent":0,"menu_order":0,"comment_status":"open","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-8716","page","type-page","status-publish","has-post-thumbnail","hentry"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.2 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Assessment Form &#187; LaurusMedical - Hemorrhoids, Varicose Vein, Gastroenterology, Dermatology<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.laurusmedical.ro\/formular-de-evaluare\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Assessment Form &#187; 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