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  🏥 Borang Maklum Balas Pesakit / Patient Feedback Form (Outpatient)

🌿 Hospital Pakar Al-Islam

Assalamualaikum dan Salam Sejahtera,
Kami amat menghargai masa anda untuk berkongsi pengalaman di Hospital Pakar Al-Islam. Maklum balas anda amat penting untuk kami meningkatkan mutu perkhidmatan, terutamanya di Jabatan Pesakit Luar.

We truly appreciate your time in sharing your experience at Al-Islam Specialist Hospital. Your feedback is essential for us to improve the quality of our services, especially in the Outpatient Department.

Semua maklumat adalah SULIT dan digunakan hanya untuk tujuan penambahbaikan.
All responses are CONFIDENTIAL and used solely for service improvement.

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Siapakah yang sedang mengisi borang ini?
Who is filling in this form? *
Sila nyatakan nama pesakit jika waris yang mengisi borang ini
Please state patient name if you are the relative or caregiver
Umur
Age *
Jantina
Gender *
Kekerapan lawatan ke hospital ini
Frequency of visit *
Dari mana anda mengetahui mengenai Hospital Pakar Al-Islam?
How do you know about Al-Islam Specialist Hospital?(boleh pilih lebih dari satu)   *
Required
Sebab utama memilih Hospital Pakar Al-Islam?
What is the main reason you chose Al-Islam Specialist Hospital? *
Required
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