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Hospital Out Patient Feedback
Please take a few moments to complete this survey
1
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2
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Name:
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Ward and IP No.:
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Email ID:
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Please enter valid email address
Contact Number:
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Invalid phone number.
The value must be less than or equal to 20
Front Office:
Excellent
Very Good
Good
Average
Poor
Ease of getting appointment
Registration and Billing
As Expected Waiting time
Staff Friendliness
Doctors:
Excellent
Very Good
Good
Average
Poor
Waiting time For Doctor
Attention and Care
Explanation of medicine
Next
Pharmacy::
Excellent
Very Good
Good
Average
Poor
All Medicine availability
Time taken to dispense me
Pharmacist response to questions
Diagnostic Service: XRay / CT / 2d-Echo:
Excellent
Very Good
Good
Average
Poor
Information before starting
Info about Report Collection
Was Technician courteous
Cleanliness of the Facility:
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Would you recommend us to a friend:
Yes
No
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Please leave your suggestions and comments here:
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Signature:
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