Patient Feedback/Suggestions Form - Savaikar Hospital

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Patient Feedback/Suggestions Form

Patient Feedback/ Suggestions Form

We are grateful to have the opportunity to serve you. To help us serve you better we request you to give us your opinion and suggestions on your experience at our hospitals. Your feedback will help us improve in serving you better

Excellent= 5 Good= 4 Fair= 3 Poor= 2 Unacceptable= 1

* Required

A. PROMPTNESS AND COURTEOUS BEHAVIOR OF THE TEAM. The Ranking to be given as follows:

Excellent Good Average Below Average Unacceptable

B. KINDLY RATE YOUR EXPERIENCE WITH THE CONSULTANT/DOCTOR. The Ranking to be given as follows :

Excellent Good Average Below Average Unacceptable

C. COURTESY OF THE NURSING STAFF. The Ranking to be given as follows :

Excellent Good Average Below Average Unacceptable

D. CLEANLINESS OF THE HOSPITAL AND TOILETS. The Ranking to be given as follows :

Excellent Good Average Below Average Unacceptable

E. CAFETERIA SERVICES AT THE HOSPITAL. The Ranking to be given as follows :

Excellent Good Average Below Average Unacceptable

F. WOULD YOU CONSIDER SAVAIKAR HOSPITAL FOR FUTURE MEDICAL NEEDS? The Ranking to be given as follows :

Excellent Good Average Below Average Unacceptable

G. If you have done a health check up with Savaikar Hospital Team ,how was your experience? The Ranking to be given as follows:

Excellent Good Average Below Average Unacceptable

Comments / Suggestions

Patient's/ Attendants Name

MR no.

Phone

Please feel free to contact our friendly reception staff with any medical enquiry, or call +91 95792 59359

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