In Patient Feedback Form

Admission

Convenience of the Admission Process (Staff Behaviour, Time Taken, Information etc.)

Very Poor Poor Average Good Excellent

Tell us what went wrong

Time taken for admission

Admission staff behaviour

Proper information on wards/services

Clarity on treatment cost & estimations

Other

Nursing

Satisfaction with Nursing Services (Staff behaviour, Response, Timely Medication, Skill, Hygiene etc.)

Very Poor Poor Average Good Excellent

Tell us what went wrong

Courtesy and care of the nursing staff

Competency in nursing care

Communication regarding patient movement for procedures/tests

Nursing staff response to call bell

Timely administration of medicines

Compliance with hygiene standards

Quality of Bed making & Other in-room procedures (Cannulization etc)

Explanation of post-discharge care

Other

Doctor Consultation

Quality of Care Provided by Doctors (Doctors Behaviour, Timely Rounds, Communication etc.)

Very Poor Poor Average Good Excellent

Tell us what went wrong

Doctors behaviour

Response to queries

Time spent by doctor(s) with patients during the rounds

Other

Housekeeping/ Cleanliness

Housekeeping Services (Regular Cleaning & Upkeep of Rooms and Toilets)

Very Poor Poor Average Good Excellent

Tell us what went wrong

Housekeeping staff behaviour

Cleaning schedule and frequency

Quality of cleaning services

Timely response to call / request

Other

General Maintenance

Functioning & Maintenance of Room Fitments (Electrical Equipment, Furniture, Bathroom/Toilet Facilities etc.)

Very Poor Poor Average Good Excellent

Tell us what went wrong

Functioning of electrical equipment

Functioning of furniture & fixtures

Functioning of bathroom fitments

TV related issues

Water related issues

Other

Dietary Services

Dietary Services (Dietician Counselling, Food Quality etc.)

Very Poor Poor Average Good Excellent

Tell us what went wrong

Counselling & guidance by dietician

Quality of food

Timely delivery of food

Other

Canteen Services

Canteen Services (Food Quality, Timely Delivery, Hygeine etc.)

Very Poor Poor Average Good Excellent

Tell us what went wrong

Quality of food

Timely delivery of food

Canteen Hygeine

Other

Radiology

Services in Radiology: X-ray, CT, USG, Other (Staff Behaviour, Time Taken etc.)

Very Poor Poor Average Good Excellent

Laboratory

Services in Laboratory (Staff Behaviour, Time Taken etc.)

Very Poor Poor Average Good Excellent

OP Pharmacy

Services in Pharmacy (Staff Behaviour, Availability of Medicines, Timely Dispatch etc.)

Very Poor Poor Average Good Excellent

Tell us what went wrong

Pharmacy staff behaviour

Waiting time in queue

Availability of prescribed medicines

Explanation of medicines and dosage

Other

Security

Security Experience (Staff Behaviour and Helpfulness)

Very Poor Poor Average Good Excellent

Physiotherapy Services

Services in Physiotherapy (Treatment , Staff Behaviour etc.)

Very Poor Poor Average Good Excellent

Discharge

Discharge Process (Discharge Speed, Summary etc.)

Very Poor Poor Average Good Excellent

Billing

Billing Experience (Staff Behaviour, Communication, Bill Accuracy etc.)

Very Poor Poor Average Good Excellent

Tell us what went wrong

Billing staff behaviour

Answers and clarification for billing queries

Accuracy of final bill

Other

Insurance

Insurance Process (Staff Behaviour, Response, Time Taken etc.)

Very Poor Poor Average Good Excellent

Patient Relations Coordinator

Very Poor Poor Average Good Excellent

PATIENT INFORMATION

IN PATIENT FEEDBACK FORM

Admission

Tell us what went wrong

Nursing

Tell us what went wrong

Doctor Consultation

Tell us what went wrong

Housekeeping/ Cleanliness

Tell us what went wrong

General Maintenance

Tell us what went wrong

Dietary Services

Tell us what went wrong

Canteen Services

Tell us what went wrong

Radiology

Tell us what went wrong

Laboratory

Tell us what went wrong

OP Pharmacy

Tell us what went wrong

Security

Tell us what went wrong

Physiotherapy Services

Tell us what went wrong

Discharge

Tell us what went wrong

Billing

Tell us what went wrong

Insurance

Tell us what went wrong

Patient Relations Coordinator

Tell us what went wrong

NET PROMOTER SCORE & FEEDBACK

Net Promoter Score *

Staff Recognition

Your reason for selecting our hospital *