Patient Feedback

Patient Name
HN Number
Gender  Male   Female
Your Name
Relation To Patient
Address
Country
Cell Number
Your Email
Your Doctor

 

DOCTORS

Care and Concern  Excellent   Good   Satisfactory   Poor 
Treated you with respect  Excellent   Good   Satisfactory   Poor 
Information & Explanation of your condition/procedure  Excellent   Good   Satisfactory   Poor 

 

NURSES

Care and Concern  Excellent   Good   Satisfactory   Poor 
Treated you with respect  Excellent   Good   Satisfactory   Poor 
Information & Explanation of your condition/procedure  Excellent   Good   Satisfactory   Poor 

 

ENVIRONMENT

Over All  Excellent   Good   Satisfactory   Poor 
Cleanliness of Toilet  Excellent   Good   Satisfactory   Poor 

 

PHARMACY

How long did you have to wait before served by a pharmacist
Less then 10 minutes  Excellent   Good   Satisfactory   Poor 
10-30 minutes  Excellent   Good   Satisfactory   Poor 
More then 30 minutes  Excellent   Good   Satisfactory   Poor 

 

Please give us your suggestion for further improvement

 

WE WISH YOU AND YOUR FAMILY THE BEST HEALTH ALWAYS