SYMBIOSIS CENTRE OF HEALTH CARE (SCHC)
Dear Symbian,

Feedback form for the Hospitalized Staff & Student
SYMBIOSIS CENTRE OF HEALTH CARE welcomes your feedback.

Your Name, Institute and course name will be strictly confidential. Please give free, frank and constructive suggestions. Our intention is to improve the system and not to victimize the beneficiary. Your feedback is valuable to upgrade the system at SCHC

Thanks & Regards

Dr. Alaka Chandak
Director, SCHC
Sign in to Google to save your progress. Learn more
Email *
* Required
Name
Category *
Academic Year
Gender
Clear selection
Name of Institute *
Campus Name *
Mobile Number
Email  ID:
Did you consult Medical Officer of SCHC prior to your hospitalization ? *
If Not consulted why ?
1. Were you aware about the process to avail benefit of Mediclaim and /or Road /Rail Traffic Accident (RTA) Policy offered by Symbiosis? *
Clear selection
2. Were you aware about the terms and conditions of Mediclaim and Road /Rail Traffic Accident (RTA) Policy offered by Symbiosis? *
Clear selection
3. Please write the name of the hospital and City in which you were admitted? *
4. Please write the date of your hospitalization.
MM
/
DD
/
YYYY
5. Which method of Mediclaim insurance policy you want to avail? *
Clear selection
6. Did any Medical Officer from SCHC visit during your hospitalization? *
Clear selection
6. Total Bill for Hospitalization
7. Have the following documents been obtained? (applicable for road & Rail traffic accidents)                               a) Panchanama Report
Clear selection
b) Medical Legal Certificate (MLC)  
Clear selection
c) First Information Report (FIR)
Clear selection
8.  Are you covered by any other health insurance plan? *
Clear selection
9. Did you experience any malpractise during your claim settlement procedure? *
(your name will not be disclosed if you point out any malpractise)
Clear selection
10. Did the Medical Officer of Symbiosis provide you proper information about your insurance claim? *
Clear selection
11. How satisfied were you with the overall performance of services offered by *                                             i) Hospital
Clear selection
ii) Symbiosis Center of Health Care - Insurance Cell
Clear selection
12. Please mention the difficulty(ies) faced during hospitalization. *
iii) Claim settlement Procedure
Clear selection
For any query, please call Medical Officer, Insurance Cell, SCHC @ 9552525015 E-mail Id- insurance@schcpune.org 
MM
/
DD
/
YYYY
"Thank You"
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Symbiosis Center of Health Care. Report Abuse