Symbiosis Centre of Health Care
Dear Symbian,

You were recently seen at the Symbiosis Centre Of Health Care for a visit. We value you as a important member of Symbiosis family and want our services to meet your needs.

We ask that you take a few moments and complete this brief survey about your most recent visit. Your responses are completely anonymous and are returned to us without any individual identifying information. The results of these questionnaires are used to evaluate and improve the services offered by the SCHC and ensure that our programs fit the needs of our students.

Participation in this survey is completely voluntary and takes about five minutes to ten minutes to complete. Please be assured of complete anonymity. We will be randomly selecting patients throughout the next several weeks to participate in the survey. If you have more than one visit to the health service, you may receive a second survey invitation. If you have any questions about this survey please contact doctor at SCHC at 9075002402/ 9552500357 or by e-mail at medicalsuperintendent@schcpune.org/ dms_hcs@schcpune.org.

Thank you for your attention and time.

Dr. Alaka Chandak
Director,SCHC

Students are requested to enter their PRN No.
Your answer
1. Enter Your Name (Optional)
Your answer
Name of the Institute
Your answer
Gender
Date of visit to SCHC
MM
/
DD
/
YYYY
Category
If category is any other please specify
Your answer
2. Have you visited SCHC before?
3. You attend Health Checkup because
Your answer
4. If yes, please specify the reason
If visit is for any other reason please specify.
Your answer
5. Does the timing of Health Checkup suit your schedule?
6. In general, how would you rate SCHC infrastructure and ambience?
Excellent
Very good
Good
Fair
Poor
Services
Location: Visibility of SCHC on campus
Ambience: Ventilation & lights
Accessibility: Adequate signage’s & display boards
Hygiene: Overall housekeeping & cleanliness
7. Were you satisfied with the services offered by the front office at SCHC?
8. What was the waiting time to meet the medical officer?
9. Did the Medical Officer explain about health checkup and flow of conduct of Health Checkup?
10. Did the medical officer at SCHC offer any advice OR treatment? Please specify:
11. Were you satisfied with the examination/ treatment / advice / referral provided by the Medical Officer?
Strongly Satisfied
Satisfied
Neither
Dissatisfied
Strongly Dissatisfied
Services 
Examination
Treatment
Advice 
Referral
12. Did the consultant at SCHC offer any advice OR treatment? Please specify:
13. Were you satisfied with the examination/ treatment / advice / referral provided by the consultant (ENT Specialist, Ophthalmologist, Dentist & Physician)? Please √
Strongly Satisfied
Satisfied
Neither
Dissatisfied
Strongly Dissatisfied
Services by Specialist 
Physician 
ENT Specialist 
Ophthalmologist
Dentist
14. Did the advice/treatment received by Medical Officer ,SCHC help to improve your health status?
16. Are you satisfied with the overall services offered by SCHC?
17. Do you have any suggestions for improvement of the services offered by SCHC? Please specify.
Your answer
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