Outpatient Feedback Form

Appointment Booking

Appointment Booking Process (Call Centre Response, Helpfulness etc.)

Very Poor Poor Average Good Excellent

Tell us what went wrong

Ease of booking appointments

Booking appointments via call centre

Response, courtesy and helpfulness of the executive

Desired slot availability

Other

Registration & Reception

Registration Experience (Efficiency, Staff Behaviour, Time Taken etc.)

Very Poor Poor Average Good Excellent

Tell us what went wrong

Efficiency of the registration process

Behaviour of the front desk executives

Time taken for the registration process

Other

Billing

Billing Experience (Response, Process, Time Taken, Accuracy etc.)

Very Poor Poor Average Good Excellent

Tell us what went wrong

Response to billing queries

Billing process

Time taken for billing

Accuracy in Billing

Other

Doctor Consultation

Doctor Experience (Behaviour, Communication, Waiting Time etc.)

Very Poor Poor Average Good Excellent

Tell us what went wrong

Doctors communication about condition & treatment

Doctors behaviour

Waiting time for consultation

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

House Keeping

Very Poor Poor Average Good Excellent

Tell us what went wrong

Room cleaning

Staff behaviour

Timely responsiveness

Other

Cafeteria

Very Poor Poor Average Good Excellent

Tell us what went wrong

Food quality

Hygiene and cleanliness

Staff behaviour

Timely food delivery

Other

Parking/Security

Very Poor Poor Average Good Excellent

Tell us what went wrong

Parking space accessibility

Parking space availability

Security behaviour

Safety and security of parking area

Other

PATIENT INFORMATION

OUTPATIENT FEEDBACK FORM

Appointment Booking

Tell us what went wrong

Registration & Reception

Tell us what went wrong

Billing

Tell us what went wrong

Doctor Consultation

Tell us what went wrong

Radiology

Tell us what went wrong

Laboratory

Tell us what went wrong

OP Pharmacy

Tell us what went wrong

House Keeping

Tell us what went wrong

Cafeteria

Tell us what went wrong

Parking/Security

Tell us what went wrong

NET PROMOTER SCORE & FEEDBACK

Net Promoter Score *

Your reason for selecting our hospital *