{"id":1341,"date":"2026-04-07T16:21:24","date_gmt":"2026-04-07T06:51:24","guid":{"rendered":"https:\/\/drbec.com.au\/?page_id=1341"},"modified":"2026-04-07T16:21:24","modified_gmt":"2026-04-07T06:51:24","slug":"feedback-form-2","status":"publish","type":"page","link":"https:\/\/drbec.com.au\/index.php\/feedback-form-2\/","title":{"rendered":"Feedback Form"},"content":{"rendered":"<style id=\"wpforms-css-vars-569-block-92ea2578-d8cc-4af3-9d33-959820ae7097\">\n\t\t\t\t#wpforms-569.wpforms-block-92ea2578-d8cc-4af3-9d33-959820ae7097 {\n\t\t\t\t--wpforms-field-size-input-height: 43px;\n--wpforms-field-size-input-spacing: 15px;\n--wpforms-field-size-font-size: 16px;\n--wpforms-field-size-line-height: 19px;\n--wpforms-field-size-padding-h: 14px;\n--wpforms-field-size-checkbox-size: 16px;\n--wpforms-field-size-sublabel-spacing: 5px;\n--wpforms-field-size-icon-size: 1;\n--wpforms-label-size-font-size: 16px;\n--wpforms-label-size-line-height: 19px;\n--wpforms-label-size-sublabel-font-size: 14px;\n--wpforms-label-size-sublabel-line-height: 17px;\n--wpforms-button-size-font-size: 17px;\n--wpforms-button-size-height: 41px;\n--wpforms-button-size-padding-h: 15px;\n--wpforms-button-size-margin-top: 10px;\n\t\t\t}\n\t\t\t<\/style><div class=\"wpforms-container wpforms-container-full wpforms-block wpforms-block-92ea2578-d8cc-4af3-9d33-959820ae7097 wpforms-render-modern\" id=\"wpforms-569\"><form id=\"wpforms-form-569\" class=\"wpforms-validate wpforms-form wpforms-ajax-form\" data-formid=\"569\" method=\"post\" enctype=\"multipart\/form-data\" action=\"\/index.php\/wp-json\/wp\/v2\/pages\/1341\" data-token=\"5225e7f4a6aed30492988e62d8edb781\" data-token-time=\"1792836903\"><div class=\"wpforms-head-container\"><div class=\"wpforms-title\">Feedback Form<\/div><\/div><noscript class=\"wpforms-error-noscript\">Please enable JavaScript in your browser to complete this form.<\/noscript><div id=\"wpforms-error-noscript\" style=\"display: none;\">Please enable JavaScript in your browser to complete this form.<\/div><div class=\"wpforms-field-container\"><div id=\"wpforms-569-field_0-container\" class=\"wpforms-field wpforms-field-name\" data-field-id=\"0\"><fieldset><legend class=\"wpforms-field-label\">Name <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-first wpforms-one-half\"><input type=\"text\" id=\"wpforms-569-field_0\" class=\"wpforms-field-name-first wpforms-field-required\" name=\"wpforms[fields][0][first]\" aria-errormessage=\"wpforms-569-field_0-error\" required><label for=\"wpforms-569-field_0\" class=\"wpforms-field-sublabel after\">First<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-569-field_0-last\" class=\"wpforms-field-name-last wpforms-field-required\" name=\"wpforms[fields][0][last]\" aria-errormessage=\"wpforms-569-field_0-last-error\" required><label for=\"wpforms-569-field_0-last\" class=\"wpforms-field-sublabel after\">Last<\/label><\/div><\/div><\/fieldset><\/div><div id=\"wpforms-569-field_24-container\" class=\"wpforms-field wpforms-field-name\" data-field-id=\"24\"><fieldset><legend class=\"wpforms-field-label\">Patient&#039;s Name<\/legend><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-first wpforms-one-half\"><input type=\"text\" id=\"wpforms-569-field_24\" class=\"wpforms-field-name-first\" name=\"wpforms[fields][24][first]\" aria-errormessage=\"wpforms-569-field_24-error\" ><label for=\"wpforms-569-field_24\" class=\"wpforms-field-sublabel after\">First<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-569-field_24-last\" class=\"wpforms-field-name-last\" name=\"wpforms[fields][24][last]\" aria-errormessage=\"wpforms-569-field_24-last-error\" ><label for=\"wpforms-569-field_24-last\" class=\"wpforms-field-sublabel after\">Last<\/label><\/div><\/div><\/fieldset><\/div><div id=\"wpforms-569-field_1-container\" class=\"wpforms-field wpforms-field-email\" data-field-id=\"1\"><label class=\"wpforms-field-label\" for=\"wpforms-569-field_1\">Email <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"email\" id=\"wpforms-569-field_1\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][1]\" spellcheck=\"false\" aria-errormessage=\"wpforms-569-field_1-error\" aria-describedby=\"wpforms-569-field_1-description\" required><div id=\"wpforms-569-field_1-description\" class=\"wpforms-field-description\">*Please provide us with an email to allow our rooms to follow up with.<\/div><\/div><div id=\"wpforms-569-field_25-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"25\"><fieldset><legend class=\"wpforms-field-label\">Which doctor did you make an appointment with? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-569-field_25\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-569-field_25_1\" name=\"wpforms[fields][25]\" value=\"Dr Rebecca Cooksey\" aria-errormessage=\"wpforms-569-field_25_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-569-field_25_1\">Dr Rebecca Cooksey<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-569-field_25_2\" name=\"wpforms[fields][25]\" value=\"Dr Michael Ee\" aria-errormessage=\"wpforms-569-field_25_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-569-field_25_2\">Dr Michael Ee<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-569-field_2-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"2\"><fieldset><legend class=\"wpforms-field-label\">Was it easy to make your child&#039;s appointment? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-569-field_2\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-569-field_2_1\" name=\"wpforms[fields][2]\" value=\"Yes\" aria-errormessage=\"wpforms-569-field_2_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-569-field_2_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-569-field_2_2\" name=\"wpforms[fields][2]\" value=\"No\" aria-errormessage=\"wpforms-569-field_2_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-569-field_2_2\">No<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"radio\" id=\"wpforms-569-field_2_3\" name=\"wpforms[fields][2]\" value=\"Unsure\" aria-errormessage=\"wpforms-569-field_2_3-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-569-field_2_3\">Unsure<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-569-field_17-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"17\"><fieldset><legend class=\"wpforms-field-label\">Were you given an appointment date within a reasonable timeframe? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-569-field_17\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-569-field_17_1\" name=\"wpforms[fields][17]\" value=\"Yes\" aria-errormessage=\"wpforms-569-field_17_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-569-field_17_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-569-field_17_2\" name=\"wpforms[fields][17]\" value=\"No\" aria-errormessage=\"wpforms-569-field_17_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-569-field_17_2\">No<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"radio\" id=\"wpforms-569-field_17_3\" name=\"wpforms[fields][17]\" value=\"Unsure\" aria-errormessage=\"wpforms-569-field_17_3-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-569-field_17_3\">Unsure<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-569-field_7-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"7\"><fieldset><legend class=\"wpforms-field-label\">Were you given options to make a convenient appointment to suit your schedule? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-569-field_7\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-569-field_7_1\" name=\"wpforms[fields][7]\" value=\"Yes\" aria-errormessage=\"wpforms-569-field_7_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-569-field_7_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-569-field_7_2\" name=\"wpforms[fields][7]\" value=\"No\" aria-errormessage=\"wpforms-569-field_7_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-569-field_7_2\">No<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"radio\" id=\"wpforms-569-field_7_3\" name=\"wpforms[fields][7]\" value=\"Unsure\" aria-errormessage=\"wpforms-569-field_7_3-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-569-field_7_3\">Unsure<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-569-field_5-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"5\"><fieldset><legend class=\"wpforms-field-label\">Did you receive a reminder of your child&#039;s appointment via text messaging? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-569-field_5\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-569-field_5_1\" name=\"wpforms[fields][5]\" value=\"Yes\" aria-errormessage=\"wpforms-569-field_5_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-569-field_5_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-569-field_5_2\" name=\"wpforms[fields][5]\" value=\"No\" aria-errormessage=\"wpforms-569-field_5_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-569-field_5_2\">No<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"radio\" id=\"wpforms-569-field_5_3\" name=\"wpforms[fields][5]\" value=\"Unsure\" aria-errormessage=\"wpforms-569-field_5_3-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-569-field_5_3\">Unsure<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-569-field_6-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"6\"><fieldset><legend class=\"wpforms-field-label\">Was the secretary you spoke with on the telephone polite and helpful? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-569-field_6\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-569-field_6_1\" name=\"wpforms[fields][6]\" value=\"Yes\" aria-errormessage=\"wpforms-569-field_6_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-569-field_6_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-569-field_6_2\" name=\"wpforms[fields][6]\" value=\"No\" aria-errormessage=\"wpforms-569-field_6_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-569-field_6_2\">No<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"radio\" id=\"wpforms-569-field_6_3\" name=\"wpforms[fields][6]\" value=\"Unsure\" aria-errormessage=\"wpforms-569-field_6_3-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-569-field_6_3\">Unsure<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-569-field_8-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"8\"><fieldset><legend class=\"wpforms-field-label\">Were you given clear information regarding your child&#039;s appointment location and time? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-569-field_8\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-569-field_8_1\" name=\"wpforms[fields][8]\" value=\"Yes\" aria-errormessage=\"wpforms-569-field_8_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-569-field_8_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-569-field_8_2\" name=\"wpforms[fields][8]\" value=\"No\" aria-errormessage=\"wpforms-569-field_8_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-569-field_8_2\">No<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"radio\" id=\"wpforms-569-field_8_3\" name=\"wpforms[fields][8]\" value=\"Unsure\" aria-errormessage=\"wpforms-569-field_8_3-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-569-field_8_3\">Unsure<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-569-field_9-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"9\"><fieldset><legend class=\"wpforms-field-label\">Were the office personnel courteous and helpful? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-569-field_9\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-569-field_9_1\" name=\"wpforms[fields][9]\" value=\"Yes\" aria-errormessage=\"wpforms-569-field_9_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-569-field_9_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-569-field_9_2\" name=\"wpforms[fields][9]\" value=\"No\" aria-errormessage=\"wpforms-569-field_9_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-569-field_9_2\">No<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"radio\" id=\"wpforms-569-field_9_3\" name=\"wpforms[fields][9]\" value=\"Unsure\" aria-errormessage=\"wpforms-569-field_9_3-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-569-field_9_3\">Unsure<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-569-field_10-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"10\"><fieldset><legend class=\"wpforms-field-label\">Were you seen on time for your appointment? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-569-field_10\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-569-field_10_1\" name=\"wpforms[fields][10]\" value=\"Yes\" aria-errormessage=\"wpforms-569-field_10_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-569-field_10_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-569-field_10_2\" name=\"wpforms[fields][10]\" value=\"No\" aria-errormessage=\"wpforms-569-field_10_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-569-field_10_2\">No<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"radio\" id=\"wpforms-569-field_10_3\" name=\"wpforms[fields][10]\" value=\"Unsure\" aria-errormessage=\"wpforms-569-field_10_3-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-569-field_10_3\">Unsure<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-569-field_26-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"26\"><fieldset><legend class=\"wpforms-field-label\">If not running on time, were you given a reason for the delay?<\/legend><ul id=\"wpforms-569-field_26\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-569-field_26_1\" name=\"wpforms[fields][26]\" value=\"Yes\" aria-errormessage=\"wpforms-569-field_26_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-569-field_26_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-569-field_26_2\" name=\"wpforms[fields][26]\" value=\"No\" aria-errormessage=\"wpforms-569-field_26_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-569-field_26_2\">No<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"radio\" id=\"wpforms-569-field_26_4\" name=\"wpforms[fields][26]\" value=\"Unsure\" aria-errormessage=\"wpforms-569-field_26_4-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-569-field_26_4\">Unsure<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-569-field_11-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"11\"><fieldset><legend class=\"wpforms-field-label\">Did you find the doctor to be professional and courteous? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-569-field_11\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-569-field_11_1\" name=\"wpforms[fields][11]\" value=\"Yes\" aria-errormessage=\"wpforms-569-field_11_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-569-field_11_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-569-field_11_2\" name=\"wpforms[fields][11]\" value=\"No\" aria-errormessage=\"wpforms-569-field_11_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-569-field_11_2\">No<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"radio\" id=\"wpforms-569-field_11_3\" name=\"wpforms[fields][11]\" value=\"Unsure\" aria-errormessage=\"wpforms-569-field_11_3-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-569-field_11_3\">Unsure<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-569-field_12-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"12\"><fieldset><legend class=\"wpforms-field-label\">Did you find the doctor to be considerate and sensitive to your child&#039;s needs? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-569-field_12\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-569-field_12_1\" name=\"wpforms[fields][12]\" value=\"Yes\" aria-errormessage=\"wpforms-569-field_12_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-569-field_12_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-569-field_12_2\" name=\"wpforms[fields][12]\" value=\"No\" aria-errormessage=\"wpforms-569-field_12_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-569-field_12_2\">No<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"radio\" id=\"wpforms-569-field_12_3\" name=\"wpforms[fields][12]\" value=\"Unsure\" aria-errormessage=\"wpforms-569-field_12_3-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-569-field_12_3\">Unsure<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-569-field_13-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"13\"><fieldset><legend class=\"wpforms-field-label\">Did the doctor cleary explain your child&#039;s treatment options to you? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-569-field_13\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-569-field_13_1\" name=\"wpforms[fields][13]\" value=\"Yes\" aria-errormessage=\"wpforms-569-field_13_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-569-field_13_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-569-field_13_2\" name=\"wpforms[fields][13]\" value=\"No\" aria-errormessage=\"wpforms-569-field_13_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-569-field_13_2\">No<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"radio\" id=\"wpforms-569-field_13_3\" name=\"wpforms[fields][13]\" value=\"Unsure\" aria-errormessage=\"wpforms-569-field_13_3-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-569-field_13_3\">Unsure<\/label><\/li><\/ul><\/fieldset><\/div>\t\t<div id=\"wpforms-569-field_3-container\"\n\t\t\tclass=\"wpforms-field wpforms-field-text\"\n\t\t\tdata-field-type=\"text\"\n\t\t\tdata-field-id=\"3\"\n\t\t\t>\n\t\t\t<label class=\"wpforms-field-label\" for=\"wpforms-569-field_3\" >you schedule? child&#039;s<\/label>\n\t\t\t<input type=\"text\" id=\"wpforms-569-field_3\" class=\"wpforms-field-medium\" name=\"wpforms[fields][3]\" >\n\t\t<\/div>\n\t\t<div id=\"wpforms-569-field_14-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"14\"><fieldset><legend class=\"wpforms-field-label\">Did the doctor answer your questions to your satisfaction? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-569-field_14\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-569-field_14_1\" name=\"wpforms[fields][14]\" value=\"Yes\" aria-errormessage=\"wpforms-569-field_14_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-569-field_14_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-569-field_14_2\" name=\"wpforms[fields][14]\" value=\"No\" aria-errormessage=\"wpforms-569-field_14_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-569-field_14_2\">No<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"radio\" id=\"wpforms-569-field_14_3\" name=\"wpforms[fields][14]\" value=\"Unsure\" aria-errormessage=\"wpforms-569-field_14_3-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-569-field_14_3\">Unsure<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-569-field_19-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"19\"><fieldset><legend class=\"wpforms-field-label\">If your child required surgery, was the surgery booking given within a reasonable timeframe?<\/legend><ul id=\"wpforms-569-field_19\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-569-field_19_1\" name=\"wpforms[fields][19]\" value=\"Yes\" aria-errormessage=\"wpforms-569-field_19_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-569-field_19_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-569-field_19_2\" name=\"wpforms[fields][19]\" value=\"No\" aria-errormessage=\"wpforms-569-field_19_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-569-field_19_2\">No<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"radio\" id=\"wpforms-569-field_19_3\" name=\"wpforms[fields][19]\" value=\"Unsure\" aria-errormessage=\"wpforms-569-field_19_3-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-569-field_19_3\">Unsure<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-569-field_22-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"22\"><fieldset><legend class=\"wpforms-field-label\">Was the information you were given for the surgery booking to your satisfaction?<\/legend><ul id=\"wpforms-569-field_22\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-569-field_22_1\" name=\"wpforms[fields][22]\" value=\"Yes\" aria-errormessage=\"wpforms-569-field_22_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-569-field_22_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-569-field_22_2\" name=\"wpforms[fields][22]\" value=\"No\" aria-errormessage=\"wpforms-569-field_22_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-569-field_22_2\">No<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"radio\" id=\"wpforms-569-field_22_3\" name=\"wpforms[fields][22]\" value=\"Unsure\" aria-errormessage=\"wpforms-569-field_22_3-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-569-field_22_3\">Unsure<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-569-field_23-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"23\"><fieldset><legend class=\"wpforms-field-label\">Were you given adequate information for surgical and financial consent? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-569-field_23\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-569-field_23_1\" name=\"wpforms[fields][23]\" value=\"Yes\" aria-errormessage=\"wpforms-569-field_23_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-569-field_23_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-569-field_23_2\" name=\"wpforms[fields][23]\" value=\"No\" aria-errormessage=\"wpforms-569-field_23_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-569-field_23_2\">No<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"radio\" id=\"wpforms-569-field_23_3\" name=\"wpforms[fields][23]\" value=\"Unsure\" aria-errormessage=\"wpforms-569-field_23_3-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-569-field_23_3\">Unsure<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-569-field_15-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"15\"><fieldset><legend class=\"wpforms-field-label\">Would you be happy to recommend the doctor you saw? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-569-field_15\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-569-field_15_1\" name=\"wpforms[fields][15]\" value=\"Highly Recommend\" aria-errormessage=\"wpforms-569-field_15_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-569-field_15_1\">Highly Recommend<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-569-field_15_2\" name=\"wpforms[fields][15]\" value=\"Probably\" aria-errormessage=\"wpforms-569-field_15_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-569-field_15_2\">Probably<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"radio\" id=\"wpforms-569-field_15_3\" name=\"wpforms[fields][15]\" value=\"Maybe\" aria-errormessage=\"wpforms-569-field_15_3-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-569-field_15_3\">Maybe<\/label><\/li><li class=\"choice-8 depth-1\"><input type=\"radio\" id=\"wpforms-569-field_15_8\" name=\"wpforms[fields][15]\" value=\"Probably Not\" aria-errormessage=\"wpforms-569-field_15_8-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-569-field_15_8\">Probably Not<\/label><\/li><li class=\"choice-9 depth-1\"><input type=\"radio\" id=\"wpforms-569-field_15_9\" name=\"wpforms[fields][15]\" value=\"Never \" aria-errormessage=\"wpforms-569-field_15_9-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-569-field_15_9\">Never<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-569-field_16-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"16\"><fieldset><legend class=\"wpforms-field-label\">How would you rate your experience at our clinic? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-569-field_16\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-569-field_16_1\" name=\"wpforms[fields][16]\" value=\"Excellent\" aria-errormessage=\"wpforms-569-field_16_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-569-field_16_1\">Excellent<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-569-field_16_2\" name=\"wpforms[fields][16]\" value=\"Good\" aria-errormessage=\"wpforms-569-field_16_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-569-field_16_2\">Good<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"radio\" id=\"wpforms-569-field_16_3\" name=\"wpforms[fields][16]\" value=\"Satisfactory\" aria-errormessage=\"wpforms-569-field_16_3-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-569-field_16_3\">Satisfactory<\/label><\/li><li class=\"choice-8 depth-1\"><input type=\"radio\" id=\"wpforms-569-field_16_8\" name=\"wpforms[fields][16]\" value=\"Unsatisfactory\" aria-errormessage=\"wpforms-569-field_16_8-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-569-field_16_8\">Unsatisfactory<\/label><\/li><li class=\"choice-9 depth-1\"><input type=\"radio\" id=\"wpforms-569-field_16_9\" name=\"wpforms[fields][16]\" value=\"Awful\" aria-errormessage=\"wpforms-569-field_16_9-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-569-field_16_9\">Awful<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-569-field_4-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"4\"><label class=\"wpforms-field-label\" for=\"wpforms-569-field_4\">If you have any suggestions on how we can improve our services please leave us a message.<\/label><textarea id=\"wpforms-569-field_4\" class=\"wpforms-field-large\" name=\"wpforms[fields][4]\" aria-errormessage=\"wpforms-569-field_4-error\" aria-describedby=\"wpforms-569-field_4-description\" ><\/textarea><div id=\"wpforms-569-field_4-description\" class=\"wpforms-field-description\">*We value and welcome your feedback.<\/div><\/div><script>\n\t\t\t\t( function() {\n\t\t\t\t\tconst style = document.createElement( 'style' );\n\t\t\t\t\tstyle.appendChild( document.createTextNode( '#wpforms-569-field_3-container { position: absolute !important; overflow: hidden !important; display: inline !important; height: 1px !important; width: 1px !important; z-index: -1000 !important; padding: 0 !important; } #wpforms-569-field_3-container input { visibility: hidden; } #wpforms-conversational-form-page #wpforms-569-field_3-container label { counter-increment: none; }' ) );\n\t\t\t\t\tdocument.head.appendChild( style );\n\t\t\t\t\tdocument.currentScript?.remove();\n\t\t\t\t} )();\n\t\t\t<\/script><\/div><!-- .wpforms-field-container --><div class=\"wpforms-submit-container\" ><input 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-->","protected":false},"excerpt":{"rendered":"","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-1341","page","type-page","status-publish","hentry"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v28.7 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Feedback Form - Dr Bec Cooksey | Paediatric Urologist | Paediatric General Surgeon<\/title>\n<meta name=\"description\" content=\"Dr Bec Cooksey | Paediatric Urologist | Paediatric General Surgeon Rebecca Cooksey is a Paediatric Urologist and Paediatric Surgeon based in Adelaide servicing the greater metro area, AdelaIde HIlls and Mount Barker\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/drbec.com.au\/index.php\/feedback-form-2\/\" \/>\n<meta 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