PATIENT SATISFACTION FEEDBACK FORM

PATIENT SATISFACTION FEEDBACK FORM

Dear Patient/ Relative/ Visitor,

Please take a few minutes to give us feedback about our service by filling in the short customer feedback form in order to measure your level of satisfaction with the quality of our service. We thank you for your participation.

 

***Kindly rate us on a scale of 1 to 5 by clicking on the stars***

1)  How satisfied are you with the customer support?

Rate us on a scale of 1-5

2) How satisfied are you with the timeliness of our service?

Rate us on a scale of 1-5

3) How satisfied are you with our staff?

a) Nurse

Rate us on a scale of 1-5

b) Medical Doctor

Rate us on a scale of 1-5

c) Audiologist

Rate us on a scale of 1-5

d) Others

Rate us on a scale of 1-5

4) How satisfied are you with the cleanliness of the hospital?

Rate us on a scale of 1-5

5) How satisfied are you with the website experience?

Rate us on a scale of 1-5

6) How would you rate your overall experience with our service?

Rate us on a scale of 1-5

7) Would you recommend us to Family and friends?

Rate us on a scale of 1-5

8) What should we change in order to live up to your expectations?

Additional comments or suggestions (if any)

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