JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
FEEDBACK FORM
PATIENT FEEDBACK for Treatment given at "Shri Hari Ayurvedic Clinic, Saharanpur"
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Your Name :
*
Your answer
Mobile No :
*
Your answer
Treatment given to you for Disease :
*
Your answer
Tell us about the treatment and how are you feeling now ( in details )
*
Your answer
Are you satisfied with our treatment
*
Choose
Yes , 100% Satisfied
50% Satisfied
Not Satisfied
Thanks for your Valuable feedback
MM
/
DD
/
YYYY
Submit
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
