JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
endofaster
Customer satisfaction and perception module
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Filled by:
*
Your answer
Location / Hospital:
*
Your answer
Comment made by:
*
Your answer
Date of communication:
*
MM
/
DD
/
YYYY
Advice / tip / Complaint:
*
Your answer
Criticality:
*
Choose
Critical for safety
Important for marketing / usability
Not critical
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. -
Terms of Service
-
Privacy Policy
Does this form look suspicious?
Report
Forms
