JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
OUTPATIENT FEEDBACK MGMCRI
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Patient Name:
*
Your answer
REG.No:
*
Your answer
Mobile Number:
*
Your answer
How Responsive Information were all staffs to your needs
Registration & other area staff
Excellent
Good
Average
Below Average
Poor
Other:
Clear selection
How do you rate the general cleanliness & ambience of the hospital
Excellent
Good
Average
Below Average
Poor
Other:
Clear selection
Your opinion about nurses ans nursing care
Excellent
Good
Average
Below Average
Poor
Other:
Clear selection
How do you rate the Laboratory Services
Excellent
Good
Average
Below Average
Poor
Other:
Clear selection
How do you rate the Radiology Services(X-RAY,USG,CT,MRI)
Excellent
Good
Average
Below Average
Poor
Other:
Clear selection
How do you rate the pharmacy Services
Excellent
Good
Average
Below Average
Poor
Other:
Clear selection
Overall Experience about the hospital services
Excellent
Good
Average
Below Average
Poor
Other:
Clear selection
Remarks & Comments:
Your answer
Submit
Page 1 of 1
Clear form
Never submit passwords through Google Forms.
Forms
This form was created inside of Mahatma Gandhi Medical College Research Institute.
Report Abuse
Terms of Service
Privacy Policy