OPD Patient Feedback Form
(Please spare your precious time to fill this form)
In Google anmelden, um den Fortschritt zu speichern. Weitere Informationen
Patient's Name *
Age/Sex
UHID No.
Address
Mobile No.
Your opinion about the
Excellent
Very good
Good
Satisfactory
Poor
Security Services
Front Office/Reception Staff
Nurse and Nursing Care Services
Doctor (s) and Medical Care Services
Pharmacy Services
Hospital Expenses
Cleanliness of the Hospital
Cleanliness of the Bathroom
Lab Services
Imaging Services
Auswahl löschen
How did you choose the OPD service in our hospital:-
How long did you wait at the registration counter?
Auswahl löschen
How long did you wait for the giving blood sample?
Auswahl löschen
Was the report of the investigation available on time?
Auswahl löschen
Is the waiting area of the hospital comfortable?
Auswahl löschen
Would you recommend the hospital to friends and relatives?
Auswahl löschen
Do you wish to appreciate any of our staff in particular, please specify his/her name wth reason?
Do you have any complaint against any of our staff, please specify his/her name?
Any other Suggestion/Comments for improving our services:
Date
TT
.
MM
.
JJJJ
Name/Relation
Your Mobile No.
Senden
Alle Eingaben löschen
Geben Sie niemals Passwörter über Google Formulare weiter.
Dieser Inhalt wurde nicht von Google erstellt und wird von Google auch nicht unterstützt. Missbrauch melden - Nutzungsbedingungen - Datenschutzerklärung
Google Formulare