JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
SURVEI KEPUASAN MASYARAKAT PUSKESMAS PEKKABATA
* Indicates required question
JAM SURVEY
Time
:
AM
PM
UMUR
*
Your answer
JENIS KELAMIN
*
LAKI-LAKI
PEREMPUAN
PENDIDIKAN
*
SD
SMP
SMA
S1
S2
S3
PEKERJAAN UTAMA
*
PNS
TNI
POLRI
SWASTA
WIRAUSAHA
Other:
PILIH LAYANAN
*
PELAYANAN LUAR GEDUNG
POLI GIGI
UGD
RAWAT INAP
PERSALINAN
POLI UMUM
POLI KIA
POLI MTBS
POLI KB
LOKET PENDAFTARAN
APOTEK
LABORATORIUM
ADMINISTRASI MANAJEMEN
PELAYANAN IMUNISASI
PELAYANAN TB/KUSTA/HIV
Next
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Report Abuse
-
Terms of Service
-
Privacy Policy
Forms
