Patient Feedback Form

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Patient Feedback Form

Kepada pelanggan yang dihargai, USAINS komited ke arah menyediakan perkhidmatan yang berkualiti bagi memenuhi kepuasan pelanggan. Sila beri maklum balas berkaitan perkhidmatan dan kemudahan di USAINS.

Dear valued customers, USAINS are committed towards providing quality services to our customers. Please help us serve you and others better by taking a few minutes to answer the questions below.

Email *

Record my email address with my response

Tarikh Rawatan / Treatment Date *

YYYY

Jantina / Gender *

Perempuan / Female

Lelaki / Male

Required

Umur / Age *

<16

16 - 40

41 - 60

> 60

Required

Rawatan yang Diterima / Treatment Received *

NEUROSURGERY

ORTHOPEDIC

RADIOLOGY

SURGERY

CARDIOLOGY

OPHTALMOLOGY

GYNEACOLOGY

PEADIATRIC

ONCOLOGY

DENTAL

LAIN-LAIN / OTHERS

Other:

Required

Tahap Kepuasan / Satisfaction Level

1 = Sangat Tidak Puas Hati / Very dissatisfied 5 = Sangat Puas Hati / Very satisfied

N/A

Temujanji / Appointment

Pendaftaran / Registration

Ruang Menunggu / Waiting Area

Bilik Konsultasi / Consultation Room

Masa Menunggu / Waiting Duration

Doktor / Doctor

Pekerja / Staff

Pembayaran / Payment

Pengambilan Ubat / Drug Dispensing

Wad / Ward

Kebersihan / Cleanliness

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