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Patient Feedback Form
Please provide feeback about your experience in our Apna Blood Bank, PALWAL
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NAME OF PATIENT
Your answer
ADDRESS OF PATIENT
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MOBILE NO OF PATIENT
Your answer
EMAIL ID
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HOW WAS YOUR EXPERIENCE
GOOD
NORMAL
POOR
Other:
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DID YOU FACE ANY INCONVENIENCE IN BLOOD BANK
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YES
NO
WOULD YOU LIKE TO RECOMMEND OTHERS TO DONATE IN OUR BLOOD BANK
Yes
No
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OVERALL RATING OF OUR BLOOD BANK
1
2
3
4
5
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