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Patient Name*:
Bed No.:
Doctor Name:
Admission Date:
Date Of Discharge:
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We thank you for choosing Bombay Hospital for Providing services to you. This questionnaire is an on going survey conducted by us to solicit your opinion about hospital. Kindly spare some time to complete this questionnaire, as it will give us invaluable feedback to improve the services.

 

# Details Excellent Good Average
1 Medical Care
2 Consultants
3 Jr. Doctors
4 Nursing Care
5 Diagnostic Dept
6 Pharmacy
7 Housekeeping (Ayah / Ward boy)
8 Laundry Services
9 Food Services
10 Security & Lift Services
11 Maintenance
12 Admission Services
Less than 1/2 hr

1 hr

more than 1 hr
13 Discharge Services
Less than 1/2 hr

1 hr

more than 1 hr
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Feedback / Suggestions