Frontier Lifeline Hospital
Out Patient Feed Back Form
Email address *
Hospital (UHID) No : *
Patient Name *
Mobile No *
Reception / Registration Services
How long did you wait before a staff attended you *
RECEPTION *
Poor
Average
Good
Excellent
Helpful & Courteous
Registration Procedure
Explained clearly Hospital, Policies
Billing Requirements
OPD SERVICES / STAFF *
Poor
Average
Good
Excellent
History taking
Helpful & Courteous
Attentive & Available
Other Department Services *
Poor
Average
Good
Excellent
X-Ray
ECG
ECHO
TMT
Laboratory Services
Patient reports Given on Time
Pharmacy
Nutrition / Diabetic Advice
DOCTORS Services *
Poor
Average
Good
Excellent
Helpful & Courteous
Availability
Services Rendered
Procedures Explained
Other Services *
Poor
Average
Good
Excellent
Coffee Shop / Food & Beverages Drinking water
Billing Counters
Security
Comments
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