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Outpatient Satisfaction Survey Form-Obstetrics and Gynaecology
Dear Patient,
We hope that we have addressed your health concerns to the best of our abilities. As we strive to improve and upgrade our facilities, a few minutes of your valuable time in answering the questionnaire below will assist us in improving our services. Kindly tick the response which best suits your experience. So help us to help you. Thank you.
Please note that all information relates to the patient.

DBSH/QLTY/PFR/OSSF/1.20 VER: 03 Effective date: 25/08/2020
1. Age: *
Required
2. Was the appointment a? *
3. Assess the registration clerks and receptionist skills on the mentioned scale? *
Unsatisfactory
Improvement Needed
Meets Expectations
Exceeds Expectations
Exceptional
Communication
Attentive While Listening
Helpful and Co-operative
Provides respectful care & personal diginity
Overall
4. The waiting time for seeing the doctor was? *
5. Assess the Doctors skills on the mentioned scale *
Unsatisfactory
Improvement Needed
Meets Expectations
Exceeds Expectations
Exceptional
Communication
Attentive while listening
Helpful and Co-operative
Provides respectful care & personal dignity
Overall
6. Did you refuse the treatment advised by the doctor? *
7. To what extent did you receive clear and helpful information before you went home about the next step *
Required
8. Would you return to this hospital if you needed medical care? *
9. How did you learn about Dr. Balwant Singh's Hospital Inc.? *
10.Please feel free to voice any other comments, suggestions and complaints faced by you that are not included in the questions above.
11.What can the hospital do to improve?
Name of patient Optional):
Registration number (Optional):
Contact telephone number (Optional):
Submit
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