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Dear Client , In order to continually improve our services and serve you better, we request you take time to fill in this form.
Personal Details
Name
Tel. Number
Email
Date(s) Served
How would your rate us in the following services? (Select most appropriate box)
Reception/Registration desk
Select One
Excellent
Good
Satisfactory
Poor
Service not used
Nursing care and response
Select One
Excellent
Good
Satisfactory
Poor
Service not used
Clinical/doctor's response
Select One
Excellent
Good
Satisfactory
Poor
Service not used
Laboratory services
Select One
Excellent
Good
Satisfactory
Poor
Service not used
Imaging (x-ray,Ultrasound)
Select One
Excellent
Good
Satisfactory
Poor
Service not used
Pharmacy services
Select One
Excellent
Good
Satisfactory
Poor
Service not used
General OUT-patient service quality
Select One
Excellent
Good
Satisfactory
Poor
Service not used
Admissions process
Select One
Excellent
Good
Satisfactory
Poor
Service not used
Quality of services in wards
Select One
Excellent
Good
Satisfactory
Poor
Service not used
Meals and catering
Select One
Excellent
Good
Satisfactory
Poor
Service not used
Discharge process
Select One
Excellent
Good
Satisfactory
Poor
Service not used
Theatre services
Select One
Excellent
Good
Satisfactory
Poor
Service not used
General IN-patient service quality
Select One
Excellent
Good
Satisfactory
Poor
Service not used
Admin/ Cashier/ Billing Services
Select One
Excellent
Good
Satisfactory
Poor
Service not used
Would you recommend our Services to Others
Yes
No
Comment
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