Hospital Ratings/Review Form
This is a small project I am working on to get responses from people I know who have visited or had an experience at any major hospital/nursing home.
I am trying to collect just basic information to aid in my project.
Please try and answer as honestly and accurately as possible!
Your Full Name
Your answer
Mobile Number
Your answer
Email Address
Your answer
Which Hospital Did You Visit
Your answer
Department Visited
Your answer
Rate the Information provided in terms of speed and reliability
This could be on the phone, via the website, via the staff
Poor
Excellent
Rate the location of the hospital
In terms of reaching easily via public/private transport, parking issues, nearby facilities etc
Poor
Excellent
Ease of Access
Disabled and children friendly, easy to walk, no steep steps etc
Poor
Excellent
Rate the Reception area and staff.
Was the reception able to serve you to your expectation. Was the staff courteous, quick and responsive?
Poor
Excellent
Rate the help desk
Prompt replies, able to help, accurate information, behaviour and attitude of staff
Poor
Excellent
Waiting Times
This could be at the registration counter, appointment times, discharge times etc
Poor
Excellent
Cleanliness of the hospital
Overall cleanliness of the area, No. of times cleaning was carried out, Attention to Hygiene
Poor
Excellent
Quality of Food and Beverages served
This would include food to admitted patients, relatives and cafetaria options along with quality and service.
Poor
Excellent
Attitute of Support and Ancillary Staff
This would be nurses, ward boys, technicians etc
Poor
Excellent
Level of Care Provided by Doctors / Specialists.
Pre diagnosis, at diagnosis and post procedure if any
Poor
Excellent
Doubt / Conflict Resolution (If Any)
Did you have a good experience clearing doubts or resolving conflicts
Poor
Excellent
Rate the billing department
Speed, accuracy, courtesy, diligence etc
Poor
Excellent
Overall Rating for the Hospital
Would you recommend your friend/relative to visit here or visit here again yourself?
Poor
Excellent
A few lines or suggestions for the hospital regarding your experience there
Your answer
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