Feedback FormFirst NameLast NameEmailPhone NumberDoctor NameCR No: Room No/Ward No: Help Desk / Front OfficeEase of contacting the hospital Poor Fair Good Very Good ExcellentClarity on expenses and packages Poor Fair Good Very Good ExcellentEfficiency of the front office team Poor Fair Good Very Good ExcellentSatisfaction with query response Poor Fair Good Very Good ExcellentSmoothness of Admission/Discharge process Poor Fair Good Very Good ExcellentComments AccomodationClarity of guidance on patient movement Poor Fair Good Very Good ExcellentWas the accommodation comfortable? Poor Fair Good Very Good ExcellentWas food served on time? Poor Fair Good Very Good ExcellentQuality of food provided Poor Fair Good Very Good ExcellentQuality of cleanliness and upkeep Poor Fair Good Very Good ExcellentWas housekeeping responsive to your needs ? Poor Fair Good Very Good ExcellentComments Medical and Nursing CareTime spent by doctors to explain diagnosis/treatment Poor Fair Good Very Good ExcellentAttention from our nursing team Poor Fair Good Very Good ExcellentPromptness of service Poor Fair Good Very Good ExcellentWere you Satisfied with the frequency of nursing visit ? Poor Fair Good Very Good Excellent.Attention from our doctors team Poor Fair Good Very Good ExcellentEfficiency of service Poor Fair Good Very Good Excellent.Quality of care provided Poor Fair Good Very Good Excellent.Comments General Feedback & DetailsHow did you select Echelon Hospital? Reputation Repeated Patient Location Insurance Tie-up Family Physician Corporate Tie-Up Website Advertising Friend/Family OtherIf Others Selected: Would you recommend our hospital to your friends and family? Poor Good Most LikelySuggestions:Date / TimeSubmit Form
