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Date of Service
 
 
 
Department
   
 
 
Overall in Service
Excellent Good Fair Should be improved
Reception
Emergency Room
Out Patient service
Cashier
Pharmacy
 
 
Overall service
Excellent Good Fair Should be improved
The overall satisfaction of services.
 
 
 
You will recommend the hospital services to friends / relatives ?
 
Yes
 
Probably
 
No

 
 
 
Will you come back to the hospital if you have any health problem?
 
Yes
 
Probably
 
No
 
 
 
Comments/Suggestions:
   
 
 
Thank you for your feedback and suggestion to improve the services. If you need a reply please give your name, telephone number or E-mail.
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