Date:
Time:
MRN No:
All information will be kept confidential and will only be used to provide a better experience to our patients.
Exceptional Exceeds expectations
Good Completely meets expectations
Adequate Sufficiently meets expectations but not fully
Unsatisfactory Does not meet expectations
1. How was your experience with the staff during registration & admission counseling? (Staff was helpful, explained the relevant details and helped in transfer to ward)
2. How was your experience with the nurses and paramedical staff? (Helpful, empathetic and supportive)
3. How was your experience with the doctor? (Approachable and answered patient care related queries)
4. How was your experience at the Pharmacy? (Accurate dispensation of medicines, minimum wait time, seamless, friendly & helpful)
5. How was your experience with Billing? (Accuracy & explanation of itemized bill, seamless, minimum wait time, friendly & helpful)
6. Rate the hospital’s cleanliness and directionals for different services. (Directional to pharmacy, X-ray room, billing etc.)
7. How was your experience with the food in the hospital? (Taste, menu options, diet counselling, serving quantity, timeliness)
8. What was your experience with the discharge process? (Discharge communication, explanation of discharge summary and wait time)
9. How do you rate your overall stay in the hospital?