Inpatient Feedback – PSG Hospitals

In Patient Feedback Form

Dear Patient / Relative / Visitor,

Your Continuing support & suggestions helps our hospital a better organisation. Kindly spare a few moments to complete the following. So that we can strive to fulfill your expectations.

Patient Name
IP Number
Date of Consultation
Dept./Unit
Doctor Name
Phone No.
- Patient
- Relative
- Visitor
Reason for choosing PSG Hospitals
- Referred by a Doctor
- Reputation of the Hospital's
- Recommended by others
- Reputation of the Doctor
- Previous experience in PSGH
Any other Reason?(Please Specify)
- Good
- Satisfactory
- Poor

	Excellent	Satisfactory	Good	Poor	NA
Admission System
Signage boards & Display
Doctors communication
Nurses communication
Billing services
Radiology Services (X-Ray,CT,MRI,Ultrasound,Mammogram)
Pharmacy Services
Discharge Process
Security Services
Dietary services
Quality of Food
Drinking Water facility
Canteen Facility
Facilities in room / ward
Cleanliness of room / ward & toilets
Wheel chair / Trolley facility

Others if any
Please notify your suggestions for further improvement of our services
Would you like to appreciate any staff for their outstanding care and services?
Name & Department
- Yes
- No

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