Patient Feedback Form
Drushti Eye And Retina Centre And Rajvi Nursing Home
CONFIDENTIAL
Telephonic Information and Interaction : *
Counter & Registration Service : *
Behavior Of Front Office Executive : *
Quality of Optometry Examination : *
Interaction With Assistant Doctor : *
Waiting Period : *
Your Consultation with Dr. Vatsal Parikh : *
Educational Literature :
Completion Of OPD Formalities and Check Out : *
Cleanliness : *
Level Of Satisfaction : *
Not Satisfied
Extremely Satisfied
Comments and Compliments :
Your answer
On a scale of 1-10, how likely are you to recommend our esteemed organisation to your friends / relatives? *
Definitely not recommend
Definitely recommend
Date of Visit : *
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Name or Ref No :
Your answer
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