Out 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
    • Relative
    • Visitor
  • Any other Reason?(Please Specify)
    • Good
    • Satisfactory
    • Poor
  • Excellent Satisfactory Good Poor NA
    Enquiry & Reception
    Signage boards & Display
    OP Reception
    Doctors communication
    Nurses communication
    Billing services
    Laboratory services
    a.Sample collection
    b.Report collection
    Radiology Services
    Pharmacy Services
    Security Services
    Waiting Area
    Drinking Water facility
    Canteen & Cafeteria
    Toilet Facilities
    Emergency / Casuality Services
    Ambulance facility
    Wheel chair & trolley facility
    Transport facility
    Total Cleanliness
  • 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