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: