Frontier Lifeline Hospital
Out Patient Feed Back Form
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Email address
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Your email
Hospital (UHID) No :
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Your answer
Patient Name
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Your answer
Mobile No
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Your answer
Reception / Registration Services
How long did you wait before a staff attended you
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Less than 10 Mins
10 - 30 Mins
More than 30 Mins
RECEPTION
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Poor
Average
Good
Excellent
Helpful & Courteous
Registration Procedure
Explained clearly Hospital, Policies
Billing Requirements
Poor
Average
Good
Excellent
Helpful & Courteous
Registration Procedure
Explained clearly Hospital, Policies
Billing Requirements
OPD SERVICES / STAFF
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Poor
Average
Good
Excellent
History taking
Helpful & Courteous
Attentive & Available
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
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
Poor
Average
Good
Excellent
Helpful & Courteous
Availability
Services Rendered
Procedures Explained
Other Services
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Poor
Average
Good
Excellent
Coffee Shop / Food & Beverages Drinking water
Billing Counters
Security
Poor
Average
Good
Excellent
Coffee Shop / Food & Beverages Drinking water
Billing Counters
Security
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