Please give us your valuable feedback. We assure you that your comments will receive our immediate attention.

Name Hospital ID Date   Doctor's Name:

How would you rate the following:   Excellent Good Average Reception? Registration process? Attentiveness of the staff? Services of the doctor? Laboratory services? Radiology services? Pharmacy services? Were you served as requested? Physiotherapy services?

Yes No Was your appointment confirmed in advance of your arrival? Was the cost conveyed to you ahead of services rendered? In case of any delay was it clarified? Were the details of your treatment explained to you clearly? Comments and suggestions: (your comments are valuable to us, as it will help us improve our services)