Out-patient Feedback

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 Name
OP 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
Enquiry & Reception
Registration
Signage boards & Display
OP Reception
Doctors communication
Nurses communication
Billing services
Laboratory services
a.Sample collection
b.Report collection
Radiology Services (X-Ray,CT,MRI,Ultrasound,Mammogram)
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

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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Out Patient Feedback Form

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