Feedback / Suggestions Feedback / Suggestions IP No.: Patient Name*: Bed No.: Doctor Name: Admission Date: Date Of Discharge: Email*: Mobile*: Address: 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 Suggestions: Captcha*:
