PATIENT FEEDBACK FORM

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

PATIENT FEEDBACK FORM

(Email the completed Feedback Form To --------------------------------------------)

Email *

Parameters ( Kindly Tick in the Appropriate Circle please rate your experience for the following ?

1.Registration and Appointment Process *

Very Good

Good

Average

Poor

Very Poor

2.Attitude and Communication by Staff / Doctors *

Very Good

Good

Average

Poor

Very Poor

3.Cleanliness and Hygiene of the Hospital *

Very Good

Good

Average

Poor

Very Poor

4. Level of Satisfaction with the Treatment received ? *

Very Good

Good

Average

Poor

Very Poor

5.Was your Treating Doctor Supervised by a Senior Doctor ? *

Yes

6.Overall Satisfaction With Your Visit to Hospital *

Very Good

Good

Average

Poor

Very Poor

7.Will You Recommend This Hospital to Family / Friends ? *

Yes

Submit

Clear form

This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy